Provider Demographics
NPI:1720269848
Name:MENTAL HEALTH SERVICES OF DONA ANA COUNTY
Entity Type:Organization
Organization Name:MENTAL HEALTH SERVICES OF DONA ANA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:E
Authorized Official - Last Name:GLASSCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSN RN CS
Authorized Official - Phone:575-649-6882
Mailing Address - Street 1:840 N TELSHOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8205
Mailing Address - Country:US
Mailing Address - Phone:575-649-6882
Mailing Address - Fax:575-373-4879
Practice Address - Street 1:3751 DEL REY BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7710
Practice Address - Country:US
Practice Address - Phone:575-649-6882
Practice Address - Fax:575-373-4879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR15936261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S95287Medicare UPIN