Healthcare Provider Details

I. General information

NPI: 1235958877
Provider Name (Legal Business Name): SACRED MINDS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 117
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

2253 CALLE DE PARIAN UNIT 1020
MESILLA NM
88046-2048
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-3637
  • Fax:
Mailing address:
  • Phone: 575-644-3637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISA ZAVALA
Title or Position: NURSE PRACTITIONER
Credential: PMHNP
Phone: 575-644-3637