Provider Demographics
NPI:1093105033
Name:NEW MEXICO STATE UNIVERSITY
Entity Type:Organization
Organization Name:NEW MEXICO STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR NMSU EAP
Authorized Official - Prefix:
Authorized Official - First Name:DARIO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-646-6603
Mailing Address - Street 1:3080 BRELAND
Mailing Address - Street 2:MSC 3529 NMSU
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88003
Mailing Address - Country:US
Mailing Address - Phone:575-646-6603
Mailing Address - Fax:
Practice Address - Street 1:3080 BRELAND
Practice Address - Street 2:MS
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88003
Practice Address - Country:US
Practice Address - Phone:575-646-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW MEXICO STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0124101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty