MEDICARE: MERIDIAN BEHAVIORAL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003458357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN BEHAVIORAL HEALTH INC

Provider Business Mailing Address
First Line	:	301 SAN ANDRES AVE NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3950
Country	:	US
Telephone Number	:	505-903-0927
Fax Number	:

Provider Business Practice Location Address
First Line	:	3908 CARLISLE BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-4504
Country	:	US
Telephone Number	:	505-903-0927
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MADELEINE WILSON
Credential	:	LCSW
Telephone Number	:	505-903-0927

Provider Enumeration Date	:	10/08/2019
Last Update Date	:	10/07/2024

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