Healthcare Provider Details

I. General information

NPI: 1205005196
Provider Name (Legal Business Name): BEHAVIOR AND FAMILY THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 E LOHMAN AVE STE 225
LAS CRUCES NM
88001-3172
US

IV. Provider business mailing address

2672 CABALLO CT
LAS CRUCES NM
88011-9000
US

V. Phone/Fax

Practice location:
  • Phone: 575-650-8415
  • Fax: 575-521-9215
Mailing address:
  • Phone: 575-650-8415
  • Fax: 575-521-9215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0101061
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberNM0943
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3644
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberM-05824
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06500
License Number StateNM
# 6
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0010C
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERT C. MAYFIELD
Title or Position: CEO
Credential: PH. D.
Phone: 575-650-8415