Provider Demographics
NPI:1720784697
Name:NEW MEXICO BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:NEW MEXICO BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:MUTIAT
Authorized Official - Middle Name:TEMITOPE
Authorized Official - Last Name:OLAWUNMI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:281-258-5344
Mailing Address - Street 1:18403 AUSTIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2277
Mailing Address - Country:US
Mailing Address - Phone:281-258-5344
Mailing Address - Fax:
Practice Address - Street 1:3695 HOT SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9549
Practice Address - Country:US
Practice Address - Phone:281-258-5344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-02
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health