Provider Demographics
NPI:1477192508
Name:TRINA KAISER LLC
Entity Type:Organization
Organization Name:TRINA KAISER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LADAC
Authorized Official - Phone:575-519-8969
Mailing Address - Street 1:425 E SKYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-3437
Mailing Address - Country:US
Mailing Address - Phone:575-519-8969
Mailing Address - Fax:
Practice Address - Street 1:425 E SKYVIEW DR
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-3437
Practice Address - Country:US
Practice Address - Phone:575-519-8969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13575279Medicaid