MEDICARE: PSYCHE BEHAVIORAL HEALTH 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1871474650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHE BEHAVIORAL HEALTH LLC

Provider Business Mailing Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE N
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7845
Country	:	US
Telephone Number	:	505-544-9630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE N
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7845
Country	:	US
Telephone Number	:	505-544-9630
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VIVIAN KAFALENOS
Credential	:
Telephone Number	:	505-544-9630

Provider Enumeration Date	:	09/09/2025
Last Update Date	:	12/02/2025

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