Provider Demographics
NPI:1760032577
Name:MENTAL HEALTH STOP LLC
Entity Type:Organization
Organization Name:MENTAL HEALTH STOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT & CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARI LYNN
Authorized Official - Middle Name:SCARLETT
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-223-8184
Mailing Address - Street 1:1096 MECHEM DR STE 213
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-7068
Mailing Address - Country:US
Mailing Address - Phone:575-223-8184
Mailing Address - Fax:
Practice Address - Street 1:1096 MECHEM DR STE 213
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-7068
Practice Address - Country:US
Practice Address - Phone:575-223-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health