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NPI Code Detail

MEDICARE: COMPLETE BEHAVIORAL HEALTH, LLC

MEDICARE: COMPLETE 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
1101YM0800XMental Health Counselor
2251B00000XCase Management Agency
3251S00000XCommunity/Behavioral Health Agency
4261Q00000XClinic/Center
5261QM0855XAdolescent and Children Mental Health Clinic/Center
6261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1992352942
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPLETE BEHAVIORAL HEALTH, LLC
Provider Business Mailing Address
First Line : PO BOX 2534
Second Line :
City : RANCHOS DE TAOS
State : NM
Zip : 87557-2534
Country : US
Telephone Number : 575-758-4297
Fax Number : 575-751-7237
Provider Business Practice Location Address
First Line : 105 BERTHA RD STE A
Second Line :
City : TAOS
State : NM
Zip : 87571-7148
Country : US
Telephone Number : 575-758-4297
Fax Number : 575-751-7237
Authorized Official
Title or Position : OWNER, CREDENTIALING SPECIALIST
Name : LISAANN TORREZ
Credential :
Telephone Number : 575-770-8136
Provider Enumeration Date : 08/23/2019
Last Update Date : 08/23/2019

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Directions to “COMPLETE BEHAVIORAL HEALTH, LLC ” Practice Location

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