Basic Information
| Provider Information | |||||||||
| NPI: | 1124530407 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH RESOURCES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W 21ST ST | ||||||||
| Address2: | |||||||||
| City: | CLOVIS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881014151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757692345 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | PORTALES | ||||||||
| State: | NM | ||||||||
| PostalCode: | 881305914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753591221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2017 | ||||||||
| LastUpdateDate: | 10/26/2017 | ||||||||
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| AuthorizedOfficialLastName: | MEZA | ||||||||
| AuthorizedOfficialFirstName: | LORRAINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMIN. ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5757692345 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.