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General NPI Number Information
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NPI Number | 1245417104
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Entity Type | Organization
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Legal Business Name | PUEBLO OF ISLETA BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 01/23/2008
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 01 SAGEBRUSH ST
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City | ISLETA
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State | NM
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Zip | 87022-0000
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Country | US
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Telephone | 505-869-4863
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Fax | 505-869-4881
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Provider Business Mailing Address
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Address Line | PO BOX 640
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City | ISLETA
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State | NM
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Zip | 87022-0000
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Country | US
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Telephone | 505-869-4863
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Fax | 505-869-4881
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | BARBARTA A MONTANO
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Credential |
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Telephone | 505-869-4863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number |
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License Number State | NM
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