MEDICARE: PRIMARY WELLNESS TEAM CORPORATION

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	103TP0016X	Prescribing (Medical) Psychologist

General Provider Information

NPI Number	:	1417489378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY WELLNESS TEAM CORPORATION

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG 1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3262
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 MCNUTT RD
Second Line	:	STE D
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-8001
Country	:	US
Telephone Number	:	575-265-1717
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHRISTIAN LIRA
Credential	:
Telephone Number	:	915-202-3232

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	06/30/2017

Similar Medicare Providers

1306797386 — SOUTH WEST MEDICAL TRANSPORT LLC
Practice Location Address:

5805 MCNUTT RD STE D
SANTA TERESA, NM
88008-8001

Practice Phone: 575-332-4007
Practice Fax:

1427616259 — SOUTHWEST PSYCHIATRY PLLC
Practice Location Address:

5805 MCNUTT RD
SANTA TERESA, NM
88008-8001

Practice Phone: 915-244-4966
Practice Fax:

1063063733 — ROCIO SANCHEZ OFFICE MANAGER
Practice Location Address:

5805 MCNUTT RD STE D
SANTA TERESA, NM
88008-8001

Practice Phone: 575-265-1717
Practice Fax: 575-332-4453

1194325308 — GREEN MINDS MATTER LLC
Practice Location Address:

5805 MCNUTT RD
SANTA TERESA, NM
88008-8001

Practice Phone: 469-569-8665
Practice Fax:

1619625704 — STF DENTAL
Practice Location Address:

5805 MCNUTT RD
SANTA TERESA, NM
88008-8001

Practice Phone: 213-200-5023
Practice Fax:

1003658774 — MONTE CRISTO HOME HEALTH LLC
Practice Location Address:

5805 MCNUTT RD STE D
SANTA TERESA, NM
88008-8001

Practice Phone: 575-332-4007
Practice Fax: 575-332-4453

Directions to “PRIMARY WELLNESS TEAM CORPORATION ” 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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.