Organization Name: | SOUTHEASTERN BEHAVIORAL ASSOCIATES, LLC |
NPI Number: | 1447640164 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHEILA ANN STEPHENSON (CO-OWNER) |
Mailing Address: | 518 E 18th St # B Portales |
State: | NM US |
Postal Code: | 881309268 |
Phone Number: | 5757143410 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2015 |
NPI Last Update Date: | 02/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0129911 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |