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General NPI Number Information
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NPI Number | 1982820387
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Entity Type | Organization
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Legal Business Name | KEA BEHAVIORAL HEALTH, PC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2812 BOSQUE DEL RIO LN NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-3130
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Country | US
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Telephone | 505-550-3688
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Fax | 505-343-3130
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Provider Business Mailing Address
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Address Line | 2812 BOSQUE DEL RIO PO BOX 27482
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City | ALBUQUERQUE, NM 87125
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State | NM
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Zip | 87125
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Country | US
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Telephone | 505-550-3688
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Fax | 505-343-3130
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Authorized Official
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Title or Position | OWNER
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Name | MS. KATHERINE ANN FIELDS
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Credential | LPCC
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Telephone | 505-550-3688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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