Provider Demographics
NPI:1457517807
Name:A NEW AWAKENING - LAS CRUCES INC.
Entity Type:Organization
Organization Name:A NEW AWAKENING - LAS CRUCES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:MCKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-224-9124
Mailing Address - Street 1:835 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2352
Mailing Address - Country:US
Mailing Address - Phone:575-993-5200
Mailing Address - Fax:505-247-9503
Practice Address - Street 1:600 1ST ST NW STE 200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2311
Practice Address - Country:US
Practice Address - Phone:505-224-9124
Practice Address - Fax:505-247-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0078391251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health