Provider Demographics
NPI:1689970329
Name:MESA BEHAVIORAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:MESA BEHAVIORAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-816-6700
Mailing Address - Street 1:6211 SAN MATEO BLVD NE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3533
Mailing Address - Country:US
Mailing Address - Phone:505-816-6700
Mailing Address - Fax:505-816-6701
Practice Address - Street 1:6211 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE 170
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3533
Practice Address - Country:US
Practice Address - Phone:505-816-6700
Practice Address - Fax:505-816-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4379483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty