Healthcare Provider Details

I. General information

NPI: 1093620767
Provider Name (Legal Business Name): VINE & BRANCH BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 FOOTHILLS RD STE 4
LAS CRUCES NM
88011-4632
US

IV. Provider business mailing address

PO BOX 13622
LAS CRUCES NM
88013-3622
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-5196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EDWARD SALAZAR
Title or Position: CEO/OWNER
Credential:
Phone: 575-644-5196