Healthcare Provider Details

I. General information

NPI: 1437437514
Provider Name (Legal Business Name): GILA BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2011
Last Update Date: 07/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CUSTER WAY
LAS CRUCES NM
88011-9071
US

IV. Provider business mailing address

2700 CUSTER WAY
LAS CRUCES NM
88011-9071
US

V. Phone/Fax

Practice location:
  • Phone: 575-313-1041
  • Fax:
Mailing address:
  • Phone: 575-313-1041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN C DUNNE
Title or Position: CEO
Credential: MA
Phone: 575-313-1041