Healthcare Provider Details

I. General information

NPI: 1366712283
Provider Name (Legal Business Name): NATIVE AMERICAN BEHAVIORAL HEALTH SERVICES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S SECOND ST STE A
GALLUP NM
87301-5898
US

IV. Provider business mailing address

1500 S SECOND ST STE A
GALLUP NM
87301-5898
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-2923
  • Fax: 505-722-2961
Mailing address:
  • Phone: 505-722-2923
  • Fax: 505-722-2961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberMD2008-0055
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberMD2008-0055
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number11959
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD K LAUGHTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-879-6575