Provider Demographics
NPI:1376340422
Name:PUEBLO OF POJOAQUE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PUEBLO OF POJOAQUE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-630-8149
Mailing Address - Street 1:2 PETROGLYPH CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87506-0984
Mailing Address - Country:US
Mailing Address - Phone:505-630-8149
Mailing Address - Fax:
Practice Address - Street 1:17746 E FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87506-8750
Practice Address - Country:US
Practice Address - Phone:505-630-8149
Practice Address - Fax:505-944-2845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PUEBLO OF POJOAQUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)