# PEDIATRIC BEHAVIORAL MEDICINE, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538425541
- **Authorized official:** JAMES W MARTIN MD (PRESIDENT)
- **Authorized official phone:** (575) 805-0849

## Contact information

- **Practice address:** 2407 W PICACHO AVE, A104, LAS CRUCES, NM 88007-4124
- **Practice address phone:** (575) 805-0849
- **Practice address fax:** (575) 541-3617
- **Mailing address:** 2407 W PICACHO AVE, A104, LAS CRUCES, NM 88007-4124
- **Mailing address phone:** (575) 805-0849
- **Mailing address fax:** (575) 541-3617

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | MD2008-0370 | NM | — |
| 2084P0800X | Psychiatry Physician | MD2008-0370 | NM | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | MD2008-0370 | NM | Yes |

## Other

- **Enumeration date:** 04/03/2012
- **Last updated:** 02/26/2013