Provider Demographics
NPI:1508488677
Name:NEW MEXICO TEEN CHALLENGE, INC.
Entity Type:Organization
Organization Name:NEW MEXICO TEEN CHALLENGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:484-868-0584
Mailing Address - Street 1:PO BOX 20610
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87154-0610
Mailing Address - Country:US
Mailing Address - Phone:706-596-8731
Mailing Address - Fax:706-596-8732
Practice Address - Street 1:1 CAMINO ORO CT
Practice Address - Street 2:
Practice Address - City:TIJERAS
Practice Address - State:NM
Practice Address - Zip Code:87059-7924
Practice Address - Country:US
Practice Address - Phone:706-596-8731
Practice Address - Fax:706-596-8732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Single Specialty