Healthcare Provider Details

I. General information

NPI: 1104338490
Provider Name (Legal Business Name): HEALTHCARE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EL PASEO RD
LAS CRUCES NM
88001-6023
US

IV. Provider business mailing address

1325 EL PASEO RD
LAS CRUCES NM
88001-6023
US

V. Phone/Fax

Practice location:
  • Phone: 575-915-1538
  • Fax: 575-288-2797
Mailing address:
  • Phone: 575-915-1538
  • Fax: 575-288-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number16402
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number16402
License Number StateNM

VIII. Authorized Official

Name: YAZID ATIEH
Title or Position: OWNER/PHARMACIST CLINICIAN
Credential: PHC
Phone: 575-915-1538