Provider Demographics
NPI:1700249570
Name:MBS PSYCHOTHERAPUTICS LLC
Entity Type:Organization
Organization Name:MBS PSYCHOTHERAPUTICS LLC
Other - Org Name:MIND IN MOTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-388-9055
Mailing Address - Street 1:526 SUN RNCH VLG LOOP
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4869
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:526 SUN RNCH VLG LOOP
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4869
Practice Address - Country:US
Practice Address - Phone:505-388-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0170091251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health