Provider Demographics
NPI:1477913697
Name:BEHAVIORAL HEALTH SERVICES OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH SERVICES OF NEW MEXICO LLC
Other - Org Name:CENTRAL DESERT BEHAVIORAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-243-3387
Mailing Address - Street 1:1525 N RENAISSANCE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-6827
Mailing Address - Country:US
Mailing Address - Phone:505-243-3387
Mailing Address - Fax:
Practice Address - Street 1:1525 N RENAISSANCE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-6827
Practice Address - Country:US
Practice Address - Phone:505-243-3387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM455996Medicare Oscar/Certification