Provider Demographics
NPI:1033546486
Name:NEW MEXICO STATE UNIVERSITY
Entity Type:Organization
Organization Name:NEW MEXICO STATE UNIVERSITY
Other - Org Name:NMSU COMMUNITY MENTAL HEALTH & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-646-4098
Mailing Address - Street 1:PO BOX 30001
Mailing Address - Street 2:O'DONNELL HALL, ROOM 047
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003-8001
Mailing Address - Country:US
Mailing Address - Phone:575-646-2065
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF STEWART STREET AND SWEET AVENUE
Practice Address - Street 2:NEW MEXICO STATE UNIVERSITY O'DONNELL HALL #047
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003-0005
Practice Address - Country:US
Practice Address - Phone:575-646-2065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-01
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health