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General NPI Number Information
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NPI Number | 1487845962
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Entity Type | Organization
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Legal Business Name | ADOLESCENT & FAMILY SERVICES
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 1630 7TH ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-4920
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Country | US
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Telephone | 505-454-8151
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Fax | 505-454-1397
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Provider Business Mailing Address
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Address Line | PO BOX 1058
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City | LAS VEGAS
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State | NM
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Zip | 87701-1058
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Country | US
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Telephone | 505-454-8151
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Fax | 505-454-1397
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Authorized Official
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Title or Position | ACTING EXECUTIVE DIRECTOR
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Name | MS. WILMA JEAN BROWN
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Credential | BA, MA, JD
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Telephone | 505-454-8151
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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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