Healthcare Provider Details

I. General information

NPI: 1134350259
Provider Name (Legal Business Name): MENTAL HEALTH ASSOCIATION OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 BRIDGE ST
LAS VEGAS NM
87701-3427
US

IV. Provider business mailing address

PO BOX 513
LAS VEGAS NM
87701-0513
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-7030
  • Fax:
Mailing address:
  • Phone: 505-425-7030
  • Fax: 505-425-7031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHEILA H SILVERMAN
Title or Position: DIRECTOR
Credential: MSW
Phone: 505-425-7030