Provider Demographics
NPI:1629326673
Name:NATIVE AMERICAN BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:NATIVE AMERICAN BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-879-0723
Mailing Address - Street 1:1500 S SECOND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5862
Mailing Address - Country:US
Mailing Address - Phone:505-879-0723
Mailing Address - Fax:
Practice Address - Street 1:1500 S SECOND ST
Practice Address - Street 2:SUITE A
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5862
Practice Address - Country:US
Practice Address - Phone:505-879-0723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1200002447323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility