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General NPI Number Information
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NPI Number | 1366514861
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Entity Type | Organization
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Legal Business Name | CORAZON BEHAVIORAL HEALTH SERVICES INC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1362 C TRINITY DRIVE
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City | LOS ALAMOS
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State | NM
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Zip | 87544
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Country | US
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Telephone | 505-662-3600
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Fax | 505-662-0937
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Provider Business Mailing Address
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Address Line | 1362 C TRINITY DRIVE
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City | LOS ALAMOS
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State | NM
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Zip | 87544
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Country | US
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Telephone | 505-662-3600
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Fax | 505-662-0937
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. REVA LEE HERON
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Credential | PHD
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Telephone | 505-662-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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