Provider Demographics
NPI:1912936774
Name:LAS CRUCES MENTAL HEALTH CENTER PC
Entity type:Organization
Organization Name:LAS CRUCES MENTAL HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAFRENIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-1888
Mailing Address - Street 1:3521 DEL REY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7708
Mailing Address - Country:US
Mailing Address - Phone:575-522-7260
Mailing Address - Fax:575-522-1355
Practice Address - Street 1:3521 DEL REY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7708
Practice Address - Country:US
Practice Address - Phone:575-522-7260
Practice Address - Fax:575-522-1355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAS CRUCES MENTAL HEALTH CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-02
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-1802084P0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty