Provider Demographics
NPI:1013559038
Name:4 DIRECTIONS INTEGRATIVE MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:4 DIRECTIONS INTEGRATIVE MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LADAC
Authorized Official - Phone:575-520-1536
Mailing Address - Street 1:PO BOX 3148
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-3148
Mailing Address - Country:US
Mailing Address - Phone:575-523-5222
Mailing Address - Fax:575-523-8031
Practice Address - Street 1:125 W BOUTZ RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3118
Practice Address - Country:US
Practice Address - Phone:575-523-5222
Practice Address - Fax:575-523-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty