Healthcare Provider Details

I. General information

NPI: 1952850455
Provider Name (Legal Business Name): DONA ANA MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 AVENIDA DE MESILLA STE D
LAS CRUCES NM
88005-3920
US

IV. Provider business mailing address

PO BOX 13022
LAS CRUCES NM
88013-3022
US

V. Phone/Fax

Practice location:
  • Phone: 575-888-7467
  • Fax: 575-233-6324
Mailing address:
  • Phone: 575-888-7467
  • Fax: 575-233-6324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0183471
License Number StateNM

VIII. Authorized Official

Name: CASSANDRA M KESTER
Title or Position: PRESIDENT
Credential: LPCC
Phone: 575-888-7467