Provider Demographics
NPI:1750540480
Name:CHILD & FAMILY WELLNESS
Entity type:Organization
Organization Name:CHILD & FAMILY WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-793-5547
Mailing Address - Street 1:1601 E 20TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4307
Mailing Address - Country:US
Mailing Address - Phone:505-793-5547
Mailing Address - Fax:
Practice Address - Street 1:1601 E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4307
Practice Address - Country:US
Practice Address - Phone:505-793-5547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96388261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1881726388OtherSINGLE PROVIDER NPI