Healthcare Provider Details

I. General information

NPI: 1962930008
Provider Name (Legal Business Name): IHS RECOVERY PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SAINT MICHAELS DR STE 2
SANTA FE NM
87505-7630
US

IV. Provider business mailing address

PO BOX 4144
SANTA FE NM
87502-4144
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-1540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0164191
License Number StateNM

VIII. Authorized Official

Name: MR. BRIAN PARKHILL
Title or Position: PRESIDENT/CEO
Credential: LPC, LADAC
Phone: 505-983-1540