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General NPI Number Information
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NPI Number | 1386953271
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Entity Type | Organization
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Legal Business Name | NEW MEXICO PROFESSIONALS RESOURCE NETWORK, LLC
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Dates
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Enumeration Date | 09/27/2010
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 6000 SUMMER AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-6738
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Country | US
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Telephone | 505-400-4806
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Fax | 505-265-3844
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Provider Business Mailing Address
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Address Line | 1405 SAN RAFAEL PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87122-1149
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Country | US
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Telephone | 505-400-4806
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Fax | 505-265-3844
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. CONSTANCE EILEEN MERRELL-MCDONALD
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Credential | LPCC, LPAT, LADAC
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Telephone | 505-400-4806
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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 | 006248
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License Number State | NM
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