Provider Demographics
NPI:1801993480
Name:ADAMS BEJARANO, LLC
Entity type:Organization
Organization Name:ADAMS BEJARANO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-690-4797
Mailing Address - Street 1:PO BOX 31428
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-1428
Mailing Address - Country:US
Mailing Address - Phone:505-690-4797
Mailing Address - Fax:505-989-8683
Practice Address - Street 1:453 CERRILLOS RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3784
Practice Address - Country:US
Practice Address - Phone:505-690-4797
Practice Address - Fax:505-989-8683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM729103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty