Healthcare Provider Details

I. General information

NPI: 1649044199
Provider Name (Legal Business Name): OLLIN MENTAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5442 RESERVE CT NE
RIO RANCHO NM
87144-6380
US

IV. Provider business mailing address

PO BOX 1232
BERNALILLO NM
87004-1232
US

V. Phone/Fax

Practice location:
  • Phone: 505-588-0414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SIBELLA SALAZAR
Title or Position: OWNER
Credential:
Phone: 505-588-0414