Organization Name: | MESCALERO |
NPI Number: | 1720292576 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLOTTE LAPAZ (MEDICAID COORDINATOR) |
Mailing Address: | 249 White Mountain Dr Mescalero |
State: | NM US |
Postal Code: | 883409622 |
Phone Number: | 5054644431 |
Fax Number: | 5054644822 |
NPI Enumeration Date: | 05/10/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |