Healthcare Provider Details

I. General information

NPI: 1043001019
Provider Name (Legal Business Name): MOODS AND MESAS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 1/2 S 3RD ST
RATON NM
87740
US

IV. Provider business mailing address

208 E 18TH ST
CIMARRON NM
87714-5002
US

V. Phone/Fax

Practice location:
  • Phone: 575-300-5729
  • Fax:
Mailing address:
  • Phone: 575-300-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA D STURGEON
Title or Position: PMHNP-BC / OWNER
Credential: PMHNP-BC
Phone: 575-300-5729