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1316391063

NPI Code Detail

MEDICARE: NORTH STAR PSYCHIATRIC SERVICES, LLC

MEDICARE: NORTH STAR PSYCHIATRIC SERVICES, LLC

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	101YM0800X	Mental Health Counselor	0168791	NM
2	103TP0016X	Prescribing (Medical) Psychologist	688	NM
3	2084P0800X	Psychiatry Physician	MD2013-0659	NM
4	2084P0804X	Child & Adolescent Psychiatry Physician	MD2013-0659	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316391063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH STAR PSYCHIATRIC SERVICES, LLC

Provider Business Mailing Address
First Line	:	195 EAST RD STE 104
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-4301
Country	:	US
Telephone Number	:	505-412-7756
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 EAST RD STE 104
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-4301
Country	:	US
Telephone Number	:	505-412-7756
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN HAIGH
Credential	:
Telephone Number	:	505-412-7756

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	06/05/2025

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1245945716 — NORTH STAR PSYCHIATRIC SERVICES LLC
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1982385472 — DR. HENRY CHRISTOPHER KOEHN PH.D., MSCP
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Directions to “NORTH STAR PSYCHIATRIC SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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