Healthcare Provider Details

I. General information

NPI: 1316751514
Provider Name (Legal Business Name): CAPACITY BUILDERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BLOOMFIELD HWY
FARMINGTON NM
87401-8110
US

IV. Provider business mailing address

2200 BLOOMFIELD HWY
FARMINGTON NM
87401-8110
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-7789
  • Fax: 505-326-1698
Mailing address:
  • Phone: 505-278-7789
  • Fax: 505-326-1698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE OFTEDAL
Title or Position: SENIOR MANAGEMENT/QUALITY CONTROL
Credential:
Phone: 505-289-7790