Healthcare Provider Details

I. General information

NPI: 1912936774
Provider Name (Legal Business Name): LAS CRUCES MENTAL HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3521 DEL REY BLVD SUITE B
LAS CRUCES NM
88012-7708
US

IV. Provider business mailing address

3521 DEL REY BLVD SUITE B
LAS CRUCES NM
88012-7708
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-7260
  • Fax: 575-522-1355
Mailing address:
  • Phone: 575-522-7260
  • Fax: 575-522-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number84-180
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number84-180
License Number StateNM

VIII. Authorized Official

Name: WILLIAM E LAFRENIERE
Title or Position: BILLING MANAGER
Credential:
Phone: 575-532-1888