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General NPI Number Information
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NPI Number | 1962632927
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Entity Type | Organization
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Legal Business Name | BOOTHEEL YOUTH ASSOCIATION
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Dates
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Enumeration Date | 07/23/2009
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Last Update Date | 07/23/2009
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Provider Practice Location Address
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Address Line | 618 PYRAMID ST
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City | LORDSBURG
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State | NM
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Zip | 88045-2000
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Country | US
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Telephone | 575-542-3908
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Fax | 575-542-3908
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Provider Business Mailing Address
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Address Line | 618 PYRAMID ST
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City | LORDSBURG
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State | NM
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Zip | 88045-2000
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Country | US
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Telephone | 575-542-3908
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Fax | 575-542-3908
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Authorized Official
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Title or Position | BYA COORDINATOR
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Name | CHRISTINE ORTIZ
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Credential |
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Telephone | 575-542-3908
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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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