Provider Demographics
NPI:1811049653
Name:MENTAL HEALTH RESOURCES, INC.
Entity type:Organization
Organization Name:MENTAL HEALTH RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:RIKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-769-2345
Mailing Address - Street 1:1100 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4151
Mailing Address - Country:US
Mailing Address - Phone:505-769-2345
Mailing Address - Fax:505-769-9013
Practice Address - Street 1:1100 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4151
Practice Address - Country:US
Practice Address - Phone:505-769-2345
Practice Address - Fax:505-769-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMK4174Medicaid
NMK4174Medicaid