Provider Demographics
NPI:1245809615
Name:TEAMBUILDERS BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:TEAMBUILDERS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUN
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-235-4002
Mailing Address - Street 1:PO BOX 28164
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-8164
Mailing Address - Country:US
Mailing Address - Phone:505-501-8974
Mailing Address - Fax:505-501-8974
Practice Address - Street 1:717 W ABRAHAMES RD STE D
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-8197
Practice Address - Country:US
Practice Address - Phone:505-384-0220
Practice Address - Fax:505-384-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01981331Medicaid