Provider Demographics
NPI:1598644809
Name:MUGSHOT MUGS
Entity type:Organization
Organization Name:MUGSHOT MUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BLANTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-785-1155
Mailing Address - Street 1:PO BOX 1207
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-1207
Mailing Address - Country:US
Mailing Address - Phone:505-785-1155
Mailing Address - Fax:
Practice Address - Street 1:50 SAN PABLO LN
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-6836
Practice Address - Country:US
Practice Address - Phone:505-785-1155
Practice Address - Fax:505-785-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health