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General NPI Number Information
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NPI Number | 1376185488
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Entity Type | Organization
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Legal Business Name | TRIQUETRA THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 19478 HIGHWAY 314
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City | BELEN
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State | NM
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Zip | 87002-8223
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Country | US
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Telephone | 505-357-4385
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Fax | 505-212-0642
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Provider Business Mailing Address
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Address Line | 1224 SILVA RD
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City | BELEN
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State | NM
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Zip | 87002-7563
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Country | US
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Telephone | 505-314-4966
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Fax | 505-212-0642
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Authorized Official
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Title or Position | PMHNP-BC
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Name | DR. DENAI FORREST
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Credential | DNP, CNP, PMHNP-BC
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Telephone | 505-357-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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