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Organization
SANDIA CREST MENTAL HEALTH LLC
Active
Organization
SANDIA CREST MENTAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD RAY LOBAUGH CNS, CNP (OWNDER)
(505) 463-2072
Entity
Organization
Contact information
Practice address
1701 US ROUTE 66, SUITE D, MORIARTY, NM 87035
(505) 384-1034
Mailing address
PO BOX 3823, MORIARTY, NM 87035-3823
(505) 463-2072
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R45675
NM
364SP0807X
Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
R45675
NM
Other
Enumeration date
04/14/2008
Last updated
09/19/2012
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