Provider Demographics
NPI:1801207105
Name:CHILD AND FAMILY WELLNESS, PC
Entity type:Organization
Organization Name:CHILD AND FAMILY WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-461-6200
Mailing Address - Street 1:102 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-2726
Mailing Address - Country:US
Mailing Address - Phone:575-461-6200
Mailing Address - Fax:575-461-0404
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2726
Practice Address - Country:US
Practice Address - Phone:575-461-6200
Practice Address - Fax:575-461-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96-388261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1881726388OtherOWNER NPI