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NPI Code Detail

MEDICARE: SOUTHEAST MENTAL HEALTH SERVICES

MEDICARE: SOUTHEAST MENTAL HEALTH SERVICES
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1518555622
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST MENTAL HEALTH SERVICES
Provider Business Mailing Address
First Line : 711 BARNES AVE
Second Line :
City : LA JUNTA
State : CO
Zip : 81050-2138
Country : US
Telephone Number : 719-384-5446
Fax Number :
Provider Business Practice Location Address
First Line : 3500 1ST ST S
Second Line :
City : LAMAR
State : CO
Zip : 81052-4327
Country : US
Telephone Number : 719-384-5400
Fax Number :
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : CAROL A ARAGON
Credential :
Telephone Number : 719-383-5408
Provider Enumeration Date : 01/05/2021
Last Update Date : 01/05/2021

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1235770561 — SOUTHEAST MENTAL HEALTH SERVICES
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Directions to “SOUTHEAST MENTAL HEALTH SERVICES ” Practice Location

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