Healthcare Provider Details

I. General information

NPI: 1194870303
Provider Name (Legal Business Name): SOUTHERN NEW MEXICO PSYCHOLOGICAL ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 DON ROSER DR
LAS CRUCES NM
88011
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-2227
  • Fax:
Mailing address:
  • Phone: 575-532-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: HOWARD B DANIELS
Title or Position: PRESIDENT
Credential: PHD
Phone: 575-532-7000