Provider Demographics
NPI:1609302454
Name:HOLISTIC MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:HOLISTIC MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:YADIRA
Authorized Official - Last Name:TALAMANTES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-680-6450
Mailing Address - Street 1:PO BOX 634
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-0634
Mailing Address - Country:US
Mailing Address - Phone:575-680-6450
Mailing Address - Fax:
Practice Address - Street 1:206 E FLEMING AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3448
Practice Address - Country:US
Practice Address - Phone:575-680-6450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-09162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health