Provider Demographics
NPI: | 1619723426 |
---|---|
Name: | SOUTHWEST THERAPEUTICS LLC |
Entity Type: | Organization |
Organization Name: | SOUTHWEST THERAPEUTICS LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ARACELI |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DURAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 575-936-4350 |
Mailing Address - Street 1: | PO BOX 1280 |
Mailing Address - Street 2: | |
Mailing Address - City: | DEMING |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 88031-1280 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 575-936-4350 |
Mailing Address - Fax: | 575-936-4351 |
Practice Address - Street 1: | 1419 S SANTA BARBARA ST |
Practice Address - Street 2: | |
Practice Address - City: | DEMING |
Practice Address - State: | NM |
Practice Address - Zip Code: | 88030-5361 |
Practice Address - Country: | US |
Practice Address - Phone: | 575-936-4350 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-04-24 |
Last Update Date: | 2024-05-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling | Group - Multi-Specialty |
No | 163WA0400X | Nursing Service Providers | Registered Nurse | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 163WP0200X | Nursing Service Providers | Registered Nurse | Pediatrics | Group - Multi-Specialty |
No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
No | 2080P0006X | Allopathic & Osteopathic Physicians | Pediatrics | Developmental - Behavioral Pediatrics | Group - Multi-Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |