Provider Demographics
NPI:1508292624
Name:BESITO MENTAL HEALTHCARE OF NEW MEXICO, LLC
Entity Type:Organization
Organization Name:BESITO MENTAL HEALTHCARE OF NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-967-9975
Mailing Address - Street 1:27 CRUCES LOOP
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-0015
Mailing Address - Country:US
Mailing Address - Phone:505-967-9975
Mailing Address - Fax:
Practice Address - Street 1:431 LUNA AVE
Practice Address - Street 2:STE. B, OFFICE A
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-967-9975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07362251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health