Provider Demographics
NPI:1851844179
Name:INSTITUTE FOR MENTAL HEALTH, P.A.
Entity Type:Organization
Organization Name:INSTITUTE FOR MENTAL HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OCTAVIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-204-2299
Mailing Address - Street 1:PO BOX 972777
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79997-2777
Mailing Address - Country:US
Mailing Address - Phone:915-801-4270
Mailing Address - Fax:915-591-4054
Practice Address - Street 1:6633 N MESA ST STE 103
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4422
Practice Address - Country:US
Practice Address - Phone:915-801-4270
Practice Address - Fax:915-591-4054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)