Healthcare Provider Details

I. General information

NPI: 1316391063
Provider Name (Legal Business Name): NORTH STAR PSYCHIATRIC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 EAST RD STE 104
LOS ALAMOS NM
87544-4301
US

IV. Provider business mailing address

195 EAST RD STE 104
LOS ALAMOS NM
87544-4301
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-7756
  • Fax:
Mailing address:
  • Phone: 505-412-7756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0168791
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number688
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2013-0659
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD2013-0659
License Number StateNM

VIII. Authorized Official

Name: DR. BRIAN HAIGH
Title or Position: OWNER
Credential:
Phone: 505-412-7756