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General NPI Number Information
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NPI Number | 1194673772
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Entity Type | Organization
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Legal Business Name | MESA PATH BEHAVIORAL AND WELLNESS LLC
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Dates
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Enumeration Date | 03/19/2026
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Last Update Date | 03/19/2026
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Provider Practice Location Address
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Address Line | 618 MANZANO ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6302
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Country | US
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Telephone | 602-706-2380
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Fax |
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Provider Business Mailing Address
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Address Line | 618 MANZANO ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6302
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Country | US
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Telephone | 602-706-2380
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MATTIE GAFFNEY
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Credential |
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Telephone | 602-706-2380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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