Provider Demographics
NPI:1689389173
Name:TRAUMA RESEARCH INTEGRATION PSYCHEDELIC SERVICES
Entity Type:Organization
Organization Name:TRAUMA RESEARCH INTEGRATION PSYCHEDELIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LPC
Authorized Official - Phone:915-526-0551
Mailing Address - Street 1:1155 WESTMORELAND DR STE 215
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-5623
Mailing Address - Country:US
Mailing Address - Phone:915-201-0702
Mailing Address - Fax:208-295-5478
Practice Address - Street 1:1155 WESTMORELAND DR STE 215
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-5623
Practice Address - Country:US
Practice Address - Phone:915-201-0702
Practice Address - Fax:208-295-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65800257Medicaid
NM98837583Medicaid