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General NPI Number Information
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NPI Number | 1487392940
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Entity Type | Organization
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Legal Business Name | LYTE PSYCHIATRY NEW MEXICO LLC
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 120 E GRAND AVE # 8
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City | CLOVIS
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State | NM
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Zip | 88101-7549
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Country | US
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Telephone | 469-733-0848
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E GRAND AVE # 8
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City | CLOVIS
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State | NM
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Zip | 88101-7549
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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 | OWNER
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Name | MR. OLUWATOYIN AWE
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Credential |
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Telephone | 817-810-6649
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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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Taxonomy #2
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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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