Healthcare Provider Details

I. General information

NPI: 1548932429
Provider Name (Legal Business Name): LOBO BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 11/22/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 NM HIGHWAY 528 LL 100
RIO RANCHO NM
87124-2167
US

IV. Provider business mailing address

PO BOX 45681
RIO RANCHO NM
87174-5681
US

V. Phone/Fax

Practice location:
  • Phone: 505-318-0470
  • Fax: 505-672-7769
Mailing address:
  • Phone: 505-318-0470
  • Fax: 505-672-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL CHAVEZ
Title or Position: OWNER
Credential:
Phone: 505-318-0470