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General NPI Number Information
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NPI Number | 1710053293
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Entity Type | Organization
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Legal Business Name | CYFD-STATE OF NEW MEXICO-TCM
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 4000 EDITH BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-2222
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Country | US
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Telephone | 505-841-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 EDITH BLVD NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87107-2222
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Country | US
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Telephone | 505-331-8562
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Fax |
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Authorized Official
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Title or Position | BUREAU CHIEF, CYFDJJS
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Name | MR. GREG NELSON
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Credential |
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Telephone | 505-331-8562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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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 | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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