Healthcare Provider Details

I. General information

NPI: 1982024105
Provider Name (Legal Business Name): DRW BEHAVIORAL HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2014
Last Update Date: 04/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 MISSOURI AVE
LAS CRUCES NM
88001-5327
US

IV. Provider business mailing address

1395 MISSOURI AVE
LAS CRUCES NM
88001-5327
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-5466
  • Fax: 575-521-8611
Mailing address:
  • Phone: 575-522-5466
  • Fax: 575-521-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number0042C
License Number StateNM

VIII. Authorized Official

Name: DR. DEBORAH L KOS
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSYD
Phone: 575-522-5466