Provider Demographics
NPI:1376577221
Name:FORENSIC BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:FORENSIC BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LPCC
Authorized Official - Phone:505-888-5499
Mailing Address - Street 1:10409 MONTGOMERY PARKWAY WEST NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-2002
Mailing Address - Country:US
Mailing Address - Phone:505-888-5499
Mailing Address - Fax:505-888-5498
Practice Address - Street 1:10409 MONTGOMERY PKWY NE
Practice Address - Street 2:WEST NE. SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3852
Practice Address - Country:US
Practice Address - Phone:505-888-5499
Practice Address - Fax:505-888-5498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM08028036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM08028036Medicaid