Provider Demographics
NPI:1164633541
Name:COMMUNITY SERVICES TRAINING INSTITUTE OF NEW MEXICO
Entity Type:Organization
Organization Name:COMMUNITY SERVICES TRAINING INSTITUTE OF NEW MEXICO
Other - Org Name:COUNSELING & PSYCHOTHERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-243-2223
Mailing Address - Street 1:PO BOX 7065
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87194-7065
Mailing Address - Country:US
Mailing Address - Phone:505-243-2223
Mailing Address - Fax:505-243-3576
Practice Address - Street 1:803 TIJERAS AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3096
Practice Address - Country:US
Practice Address - Phone:505-243-2223
Practice Address - Fax:505-243-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35370025Medicaid
NMNM600145OtherVALUE OPTIONS NM ID
NM324612Medicare Oscar/Certification