Provider Demographics
NPI:1598000721
Name:NEUROMENTAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:NEUROMENTAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MP
Authorized Official - Phone:505-508-5575
Mailing Address - Street 1:711 ENCINO PL NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2649
Mailing Address - Country:US
Mailing Address - Phone:505-508-5575
Mailing Address - Fax:310-534-5591
Practice Address - Street 1:711 ENCINO PL NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2649
Practice Address - Country:US
Practice Address - Phone:505-508-5575
Practice Address - Fax:310-534-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1035261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health