Basic Information
| Provider Information | |||||||||
| NPI: | 1609886787 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BORDER AREA MENTAL HEALTH SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1349 | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880621349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 S. HUDSON | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 04/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | HUNT | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5753884497 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW LPCC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | 3041 | NM | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | E8826 | 05 | NM | MEDICAID |