Provider Demographics
NPI:1396400982
Name:BETTER VIDA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:BETTER VIDA BEHAVIORAL HEALTH
Other - Org Name:BETTER VIDA BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VALDIVIEZO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-621-4462
Mailing Address - Street 1:4318 TEWA CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4348
Mailing Address - Country:US
Mailing Address - Phone:575-621-4462
Mailing Address - Fax:
Practice Address - Street 1:4318 TEWA CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4348
Practice Address - Country:US
Practice Address - Phone:575-621-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty