Provider Demographics
NPI:1134450364
Name:LA FAMILIA MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:LA FAMILIA MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-623-1220
Mailing Address - Street 1:105 W 3RD ST STE 234
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4772
Mailing Address - Country:US
Mailing Address - Phone:575-623-1220
Mailing Address - Fax:575-623-1240
Practice Address - Street 1:105 W 3RD ST STE 234
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4772
Practice Address - Country:US
Practice Address - Phone:575-623-1220
Practice Address - Fax:575-623-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-07156251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health