Provider Demographics
NPI:1194017558
Name:RIO GRANDE PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:RIO GRANDE PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:MERTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-526-1036
Mailing Address - Street 1:11 LEBANON ARC
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3749
Mailing Address - Country:US
Mailing Address - Phone:575-526-1036
Mailing Address - Fax:575-524-1317
Practice Address - Street 1:11 LEBANON ARC
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3749
Practice Address - Country:US
Practice Address - Phone:575-526-1036
Practice Address - Fax:575-524-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM542103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty