Healthcare Provider Details

I. General information

NPI: 1518823004
Provider Name (Legal Business Name): SER HUMANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 LOS MILAGROS
SANTA FE NM
87507-1611
US

IV. Provider business mailing address

3924 LOS MILAGROS
SANTA FE NM
87507-1611
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-1419
  • Fax:
Mailing address:
  • Phone: 505-310-1419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AUGUST BERRY
Title or Position: MENTAL HEALTH THERAPIST
Credential: LCSW
Phone: 505-310-1419