| Organization Name: | SANDIA CREST MENTAL HEALTH LLC |
| NPI Number: | 1932373743 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EDWARD RAY LOBAUGH (OWNDER) |
| Mailing Address: | 1701 Us Route 66 Suite D Moriarty |
| State: | NM US |
| Postal Code: | 87035 |
| Phone Number: | 5053841034 |
| Fax Number: | |
| NPI Enumeration Date: | 04/14/2008 |
| NPI Last Update Date: | 09/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0807X |
| License Number: | R45675 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Psych/Mental Health, Child & Adolescent |
| Taxonomy Definition: | |