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General NPI Number Information
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NPI Number | 1548677669
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Entity Type | Organization
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Legal Business Name | WINDS OF CHANGE MENTAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 200 N 1ST ST STE B
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City | GRANTS
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State | NM
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Zip | 87020-3905
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Country | US
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Telephone | 505-290-4551
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Fax | 505-658-2398
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Provider Business Mailing Address
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Address Line | PO BOX 178
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City | GRANTS
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State | NM
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Zip | 87020-0178
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Country | US
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Telephone | 505-290-4551
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Fax | 505-658-2398
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENEE H WILKINS
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Credential | PSYD
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Telephone | 505-290-4551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 0034
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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