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General NPI Number Information
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NPI Number | 1467685644
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Entity Type | Organization
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Legal Business Name | NEW MEXICO RESOURCE CENTER FOR HEALTH PROFESSIONALS
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 11930 MENAUL BLVD NE SUITE 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2478
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Country | US
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Telephone | 505-332-9242
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Fax | 505-332-9140
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Provider Business Mailing Address
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Address Line | 11930 MENAUL BLVD NE SUITE 101
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City | ALBUQUERQUE
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State | NM
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Zip | 87112-2478
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Country | US
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Telephone | 505-332-9242
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Fax | 505-332-9140
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MRS. CONSTANCE EILEEN MERRELL-MCDONALD
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Credential | LPCC, LPAT, LADAC
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Telephone | 505-332-9424
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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 |
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License Number State |
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