Healthcare Provider Details

I. General information

NPI: 1245809615
Provider Name (Legal Business Name): TEAMBUILDERS BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 W ABRAHAMES RD STE D
MORIARTY NM
87035-8197
US

IV. Provider business mailing address

PO BOX 28164
SANTA FE NM
87592-8164
US

V. Phone/Fax

Practice location:
  • Phone: 505-384-0220
  • Fax: 505-384-0222
Mailing address:
  • Phone: 505-501-8974
  • Fax: 505-501-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUN VEGA
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 505-235-4002