Provider Demographics
NPI:1386283943
Name:LUXE PSYCHIATRIC AND WELLNESS SERVICES LLC
Entity type:Organization
Organization Name:LUXE PSYCHIATRIC AND WELLNESS SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNNET
Authorized Official - Middle Name:
Authorized Official - Last Name:BULAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-840-4888
Mailing Address - Street 1:401 MISSION ARCH DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6792
Mailing Address - Country:US
Mailing Address - Phone:575-840-4888
Mailing Address - Fax:
Practice Address - Street 1:613 W 2ND ST STE 3
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4671
Practice Address - Country:US
Practice Address - Phone:210-900-0729
Practice Address - Fax:575-627-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty