Provider Demographics
NPI:1598063372
Name:TAOS PUEBLO BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:TAOS PUEBLO BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIVISION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-758-7824
Mailing Address - Street 1:PO BOX 1846
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1846
Mailing Address - Country:US
Mailing Address - Phone:575-758-7824
Mailing Address - Fax:575-758-3346
Practice Address - Street 1:236 ROTTEN TREE ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-1846
Practice Address - Country:US
Practice Address - Phone:575-758-7824
Practice Address - Fax:575-758-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM298251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health