MEDICARE: COMPREHENSIVE PSYCHOLOGY 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	103TC0700X	Clinical Psychologist	1210	NM

General Provider Information

NPI Number	:	1932698875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE PSYCHOLOGY SERVICES LLC

Provider Business Mailing Address
First Line	:	1513 SAN CARLOS RD SW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87104-1042
Country	:	US
Telephone Number	:	575-574-0267
Fax Number	:	575-388-1035

Provider Business Practice Location Address
First Line	:	1915 N SWAN ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5779
Country	:	US
Telephone Number	:	575-574-0267
Fax Number	:	575-388-1035

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST
Name	:	DR. LISA HOUSTON
Credential	:	PHD
Telephone Number	:	575-574-0267

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	04/15/2026

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