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General NPI Number Information
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NPI Number | 1154147601
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Entity Type | Organization
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Legal Business Name | ELITE MIND AND BODY WELLNESS: MENTAL HEALTH AND PRIMARY CARE SERVICES,
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 519 SHILOH RD
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City | MESILLA PARK
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State | NM
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Zip | 88047-9745
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Country | US
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Telephone | 575-644-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 519 SHILOH RD
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City | MESILLA PARK
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State | NM
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Zip | 88047-9745
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Country | US
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Telephone | 575-644-6367
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Fax |
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Authorized Official
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Title or Position | OWNER/AUTHORIZED OFFICIAL
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Name | MS. MARYBETH A PIRRONE
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Credential | APRN, FNP, PMHNP-C
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Telephone | 575-644-6367
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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