Healthcare Provider Details

I. General information

NPI: 1134194483
Provider Name (Legal Business Name): CHOICES BEHAVIORAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 06/12/2023
Certification Date: 06/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W APACHE ST
FARMINGTON NM
87401-5835
US

IV. Provider business mailing address

313 W APACHE ST
FARMINGTON NM
87401-5835
US

V. Phone/Fax

Practice location:
  • Phone: 505-325-5321
  • Fax: 505-325-6453
Mailing address:
  • Phone: 505-325-5321
  • Fax: 505-325-6453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM POGUE
Title or Position: PRESIDENT
Credential:
Phone: 505-325-5321