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General NPI Number Information
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NPI Number | 1003218553
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Entity Type | Organization
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Legal Business Name | INTEGRATED HEALTHCARE OF NEW MEXICO
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 09/16/2014
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Provider Practice Location Address
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Address Line | 7632 WILLIAM MOYERS AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-2765
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Country | US
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Telephone | 505-554-1716
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Fax | 505-792-5222
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Provider Business Mailing Address
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Address Line | 7632 WILLIAM MOYERS AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-2765
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Country | US
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Telephone | 505-554-1716
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Fax | 505-792-5222
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Authorized Official
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Title or Position | CEO
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Name | DR. STEPHEN L CHESHIRE III
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Credential | PHD
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Telephone | 505-554-1716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 1251
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License Number State | NM
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