Healthcare Provider Details

I. General information

NPI: 1093656241
Provider Name (Legal Business Name): CLEVERISED BEHAVIORAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S MAIN ST STE 1
LAS CRUCES NM
88005-2911
US

IV. Provider business mailing address

901 S MAIN ST
LAS CRUCES NM
88005-2911
US

V. Phone/Fax

Practice location:
  • Phone: 702-426-8050
  • Fax:
Mailing address:
  • Phone: 702-426-8050
  • Fax: 702-426-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: TOMEKA ANDERSON
Title or Position: OWNER/FOUNDER
Credential: ANDERSON
Phone: 702-426-8050