Healthcare Provider Details

I. General information

NPI: 1376340422
Provider Name (Legal Business Name): PUEBLO OF POJOAQUE BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17746 E FRONTAGE RD
SANTA FE NM
87506-8750
US

IV. Provider business mailing address

2 PETROGLYPH CIR
SANTA FE NM
87506-0984
US

V. Phone/Fax

Practice location:
  • Phone: 505-630-8149
  • Fax: 505-944-2845
Mailing address:
  • Phone: 505-630-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CIARA MUSSER
Title or Position: PSYCHIATRIC NURSE PRACTITIONER
Credential: CNP
Phone: 505-630-8149