Healthcare Provider Details

I. General information

NPI: 1407632383
Provider Name (Legal Business Name): BEHAVIORAL HEALTHCARE SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W BOUTZ RD BLDG 2D
LAS CRUCES NM
88005-3261
US

IV. Provider business mailing address

205 W BOUTZ RD STE D
LAS CRUCES NM
88005-3262
US

V. Phone/Fax

Practice location:
  • Phone: 575-520-2861
  • Fax: 575-652-4937
Mailing address:
  • Phone: 575-650-4357
  • 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: TRACY PEREZ
Title or Position: OFFICE MANAGER/BILLER
Credential:
Phone: 575-650-4357