Healthcare Provider Details

I. General information

NPI: 1457043184
Provider Name (Legal Business Name): ATHENA MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4091 SOTOL DR
LAS CRUCES NM
88011-7640
US

IV. Provider business mailing address

141 N ROADRUNNER PKWY STE 141
LAS CRUCES NM
88011-2000
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-1603
  • Fax:
Mailing address:
  • Phone:
  • 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: SHELBY WASHINGTON
Title or Position: CONSULTANT
Credential:
Phone: 678-383-0907