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General NPI Number Information
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NPI Number | 1457119489
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Entity Type | Organization
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Legal Business Name | STABILITY PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 6001 MENAUL BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3379
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Country | US
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Telephone | 505-585-8483
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Fax |
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Provider Business Mailing Address
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Address Line | 182 PRAIRIE WIND DR
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City | WENTZVILLE
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State | MO
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Zip | 63385-2747
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | JELYA FATAWU
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Credential | APRN
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Telephone | 216-246-5697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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