Healthcare Provider Details

I. General information

NPI: 1235773367
Provider Name (Legal Business Name): MR. PATRICK ALLEN RAMSEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MAIN ST
LAS CRUCES NM
88001-1281
US

IV. Provider business mailing address

2420 WASHINGTON WOODS RD
SOUTHAVEN MS
38672-1060
US

V. Phone/Fax

Practice location:
  • Phone: 575-600-6575
  • Fax:
Mailing address:
  • Phone: 662-879-7154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB20260013
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: