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General NPI Number Information
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NPI Number | 1376340422
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Entity Type | Organization
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Legal Business Name | PUEBLO OF POJOAQUE BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 17746 E FRONTAGE RD
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City | SANTA FE
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State | NM
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Zip | 87506-8750
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Country | US
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Telephone | 505-630-8149
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Fax | 505-944-2845
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Provider Business Mailing Address
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Address Line | 2 PETROGLYPH CIR
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City | SANTA FE
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State | NM
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Zip | 87506-0984
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Country | US
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Telephone | 505-630-8149
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | CIARA MUSSER
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Credential | CNP
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Telephone | 505-630-8149
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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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