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General NPI Number Information
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NPI Number | 1306389580
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Entity Type | Organization
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Legal Business Name | SOUTHWEST CENTER FOR CHILD AND FAMILY DEVELOPMENT, LLC
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 3250 TRINITY DR STE D-3
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City | LOS ALAMOS
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State | NM
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Zip | 87544-2226
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Country | US
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Telephone | 505-412-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 TRINITY DR STE D-3
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City | LOS ALAMOS
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State | NM
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Zip | 87544-2226
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Country | US
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Telephone | 505-412-4044
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Fax |
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Authorized Official
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Title or Position | OWNER, CLINICAL PSYCHOLOGIST
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Name | DR. TINA GOLDSMITH
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Credential | PH.D., BCBA-D
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Telephone | 505-412-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1155
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License Number State | NM
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