Provider Demographics
NPI:1992352942
Name:COMPLETE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:COMPLETE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LISAANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TORREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-770-8136
Mailing Address - Street 1:PO BOX 2534
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-2534
Mailing Address - Country:US
Mailing Address - Phone:575-758-4297
Mailing Address - Fax:575-751-7237
Practice Address - Street 1:105 BERTHA RD STE A
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7148
Practice Address - Country:US
Practice Address - Phone:575-758-4297
Practice Address - Fax:575-751-7237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health