Healthcare Provider Details

I. General information

NPI: 1043055916
Provider Name (Legal Business Name): SUMMIT BHC NEW MEXICO CTC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 COPPER LOOP STE B
LAS CRUCES NM
88005-8141
US

IV. Provider business mailing address

1050-B COPPER LOOP
LAS CRUCES NM
88005
US

V. Phone/Fax

Practice location:
  • Phone: 888-727-4770
  • Fax:
Mailing address:
  • Phone: 888-727-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JAMES STEPHEN HINKLE
Title or Position: GENERAL COUNSEL & SECRETARY
Credential:
Phone: 615-637-7218