Provider Demographics
NPI:1760102313
Name:FAITH MENTAL HEALTH AND WELLNESS SERVICES LLC
Entity Type:Organization
Organization Name:FAITH MENTAL HEALTH AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-290-3122
Mailing Address - Street 1:204 144TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-6277
Mailing Address - Country:US
Mailing Address - Phone:806-535-3104
Mailing Address - Fax:
Practice Address - Street 1:8206 LOUISIANA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1738
Practice Address - Country:US
Practice Address - Phone:806-535-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty