Provider Demographics
NPI:1386226389
Name:LAND OF ENCHANTMENT YOUTH SERVICES
Entity Type:Organization
Organization Name:LAND OF ENCHANTMENT YOUTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEHR
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-948-1811
Mailing Address - Street 1:1424 DEBORAH RD SE STE 205
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6619
Mailing Address - Country:US
Mailing Address - Phone:505-750-4855
Mailing Address - Fax:
Practice Address - Street 1:1424 DEBORAH RD SE STE 205
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6619
Practice Address - Country:US
Practice Address - Phone:505-636-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAND OF ENCHANTMENT YOUTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM513118635OtherDRIVERS LICENSE