Healthcare Provider Details

I. General information

NPI: 1801484712
Provider Name (Legal Business Name): MINDCALM PSYCHIATRIC & BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 WASHINGTON AVE STE 201
SANTA FE NM
87501-2038
US

IV. Provider business mailing address

PO BOX 271322
FLOWER MOUND TX
75027-1322
US

V. Phone/Fax

Practice location:
  • Phone: 505-395-4690
  • Fax: 978-378-2056
Mailing address:
  • Phone: 505-395-4690
  • Fax: 978-378-2056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRACIE L THOMAS
Title or Position: OWNER
Credential: NP
Phone: 505-395-4690