Provider Demographics
NPI:1023818176
Name:INSIDE OUT
Entity type:Organization
Organization Name:INSIDE OUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:CPSW, CCSS, CHW
Authorized Official - Phone:505-367-3500
Mailing Address - Street 1:908 N RIVERSIDE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2916
Mailing Address - Country:US
Mailing Address - Phone:505-367-3500
Mailing Address - Fax:505-367-3503
Practice Address - Street 1:908 N RIVERSIDE DR STE 6
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2916
Practice Address - Country:US
Practice Address - Phone:505-367-3500
Practice Address - Fax:505-367-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No347C00000XTransportation ServicesPrivate Vehicle