Healthcare Provider Details

I. General information

NPI: 1548606577
Provider Name (Legal Business Name): NEW VISION BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 GOLF COURSE RD SE STE 202
RIO RANCHO NM
87124-2071
US

IV. Provider business mailing address

1515 GOLF COURSE RD SE STE 202
RIO RANCHO NM
87124-2071
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-7479
  • Fax: 505-892-5449
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN RICHARD WHITE
Title or Position: OWNER
Credential: CNP, PMHNP-BC, LCSW
Phone: 505-414-7479