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General NPI Number Information
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NPI Number | 1720292576
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Entity Type | Organization
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Legal Business Name | MESCALERO
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 249 WHITE MOUNTAIN DR
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City | MESCALERO
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State | NM
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Zip | 88340-9622
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Country | US
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Telephone | 505-464-4431
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Fax | 505-464-4822
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Provider Business Mailing Address
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Address Line | 249 WHITE MOUNTAIN DR
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City | MESCALERO
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State | NM
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Zip | 88340-9622
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Country | US
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Telephone | 505-464-4431
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Fax | 505-464-4822
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Authorized Official
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Title or Position | MEDICAID COORDINATOR
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Name | CHARLOTTE LAPAZ
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Credential |
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Telephone | 505-464-4431
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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