Provider Demographics
NPI:1780430181
Name:HEARTSPACE NEW MEXICO LLC
Entity type:Organization
Organization Name:HEARTSPACE NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:H
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:214-676-3879
Mailing Address - Street 1:14 MILLERS END
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9405
Mailing Address - Country:US
Mailing Address - Phone:214-676-3879
Mailing Address - Fax:214-292-9313
Practice Address - Street 1:14 MILLERS END
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9405
Practice Address - Country:US
Practice Address - Phone:214-676-3879
Practice Address - Fax:214-292-9313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-26
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty