Basic Information
| Provider Information | |||||||||
| NPI: | 1528421179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BEHAVIORAL HEALTH WORKS, NEW MEXICO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 E ORANGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928056807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002491266 | ||||||||
| FaxNumber: | 8003858191 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 SUN AVE NE STE 650 | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871094670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002491266 | ||||||||
| FaxNumber: | 8003858191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2016 | ||||||||
| LastUpdateDate: | 06/02/2016 | ||||||||
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| AuthorizedOfficialLastName: | LIM | ||||||||
| AuthorizedOfficialFirstName: | MONTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPLIANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8002491266 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MPP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.