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General NPI Number Information
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NPI Number | 1669729711
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Entity Type | Organization
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Legal Business Name | THE PSYCHIATRIC CARE CENTER LLC
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 07/04/2024
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Provider Practice Location Address
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Address Line | 405 W 4TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6364
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Country | US
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Telephone | 575-226-3898
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Fax | 575-226-3890
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Provider Business Mailing Address
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Address Line | 405 W 4TH ST
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City | PORTALES
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State | NM
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Zip | 88130-6364
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Country | US
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Telephone | 575-226-3898
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Fax | 575-226-3890
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Authorized Official
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Title or Position | CERTIFIED NURSE PRACTITIONER
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Name | CASEY TURNBOUGH
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Credential | MSN, PMHNP-BC
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Telephone | 575-219-9596
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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 | CNP01666
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License Number State | NM
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