Provider Demographics
NPI:1508548850
Name:HIGH DESERT BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:HIGH DESERT BEHAVIORAL HEALTH LLC
Other - Org Name:MINDFUL MEDICATION MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-591-0636
Mailing Address - Street 1:3510 MESSINA DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4782
Mailing Address - Country:US
Mailing Address - Phone:505-591-0636
Mailing Address - Fax:
Practice Address - Street 1:3510 MESSINA DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87402-4782
Practice Address - Country:US
Practice Address - Phone:505-591-0636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty