Provider Demographics
NPI:1205005196
Name:BEHAVIOR AND FAMILY THERAPY SERVICES
Entity Type:Organization
Organization Name:BEHAVIOR AND FAMILY THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:575-650-8415
Mailing Address - Street 1:2672 CABALLO CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9000
Mailing Address - Country:US
Mailing Address - Phone:575-650-8415
Mailing Address - Fax:575-521-9215
Practice Address - Street 1:1990 E LOHMAN AVE STE 225
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:575-650-8415
Practice Address - Fax:575-521-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0101061101YP2500X
NMNM0943103TC1900X
NM0010C103TP0016X
NMI-36441041C0700X
NMM-058241041C0700X
NMI-065001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10075381Medicaid
NMB2154Medicare PIN