Provider Demographics
NPI:1770078321
Name:NATIVE BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:NATIVE BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:AGLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-470-5272
Mailing Address - Street 1:4001 OFFICE COURT DR STE 303
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4930
Mailing Address - Country:US
Mailing Address - Phone:505-395-9456
Mailing Address - Fax:505-930-5114
Practice Address - Street 1:4001 OFFICE COURT DR STE 303
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4930
Practice Address - Country:US
Practice Address - Phone:505-395-9456
Practice Address - Fax:505-930-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-081631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM432Medicaid