Provider Demographics
NPI:1003218553
Name:INTEGRATED HEALTHCARE OF NEW MEXICO
Entity Type:Organization
Organization Name:INTEGRATED HEALTHCARE OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHESHIRE
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-554-1716
Mailing Address - Street 1:7632 WILLIAM MOYERS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2765
Mailing Address - Country:US
Mailing Address - Phone:505-554-1716
Mailing Address - Fax:505-792-5222
Practice Address - Street 1:7632 WILLIAM MOYERS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2765
Practice Address - Country:US
Practice Address - Phone:505-554-1716
Practice Address - Fax:505-792-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1251103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty