Provider Demographics
NPI:1508500174
Name:WIND SONG BEHAVIORAL HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:WIND SONG BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFCOAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-672-7668
Mailing Address - Street 1:224 W COAL AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6306
Mailing Address - Country:US
Mailing Address - Phone:970-672-7668
Mailing Address - Fax:
Practice Address - Street 1:224 W COAL AVE
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-6306
Practice Address - Country:US
Practice Address - Phone:970-672-7668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health