MEDICARE: WAY OF HARMONY BEHAVIORAL HEALTH SERVICES, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1043199912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAY OF HARMONY BEHAVIORAL HEALTH SERVICES, PLLC

Provider Business Mailing Address
First Line	:	1061 BOLING LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-4865
Country	:	US
Telephone Number	:	515-988-1800
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 BOLING LN
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-4865
Country	:	US
Telephone Number	:	515-988-1800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DOUGLAS JOHN DETRICK
Credential	:	LISW
Telephone Number	:	515-988-1800

Provider Enumeration Date	:	08/27/2025
Last Update Date	:	08/27/2025

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