Healthcare Provider Details

I. General information

NPI: 1124530407
Provider Name (Legal Business Name): MENTAL HEALTH RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 1ST ST
PORTALES NM
88130-5914
US

IV. Provider business mailing address

1100 W 21ST ST
CLOVIS NM
88101-4151
US

V. Phone/Fax

Practice location:
  • Phone: 575-359-1221
  • Fax:
Mailing address:
  • Phone: 575-769-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRAD RIKEL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-769-2345