Provider Demographics
NPI:1760865968
Name:MINDCARE SOLUTIONS OF NEW MEXICO PC
Entity Type:Organization
Organization Name:MINDCARE SOLUTIONS OF NEW MEXICO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OP LICENSING CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-291-4535
Mailing Address - Street 1:405 DUKE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2706
Mailing Address - Country:US
Mailing Address - Phone:844-291-4535
Mailing Address - Fax:
Practice Address - Street 1:306 E NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5794
Practice Address - Country:US
Practice Address - Phone:844-291-4535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty