Healthcare Provider Details

I. General information

NPI: 1902659295
Provider Name (Legal Business Name): CRAVENS MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GOLF COURSE RD SE STE 203
RIO RANCHO NM
87124-4731
US

IV. Provider business mailing address

1101 GOLF COURSE RD SE STE 203
RIO RANCHO NM
87124-4731
US

V. Phone/Fax

Practice location:
  • Phone: 505-518-5757
  • Fax: 505-461-6217
Mailing address:
  • Phone: 505-518-5757
  • Fax: 505-461-6217

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: MRS. ANGELICA CRAVENS
Title or Position: OWNER
Credential: LCSW
Phone: 505-518-5757