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Organization
TELEMENTAL HEALTH LINK LLC
Active
Organization
TELEMENTAL HEALTH LINK LLC
Active
Parent organization
TELEMENTAL HEALTH LINK LLC
Other names
TELEMENTAL HEALTH LINK -NM, Telemental Health Link New Mexico, THL New Mexico
Organization subpart
Yes
Provider details
NPI number
Legal business name
TELEMENTAL HEALTH LINK LLC
Authorized official
SUSAN M DERIVAS PMHNP-BC (AO)
(208) 775-7418
Entity
Organization
Contact information
Practice address
5700 HARPER DR NE STE 210-4, ALBUQUERQUE, NM 87109-3573
(208) 775-7418
(208) 768-4500
Mailing address
4055 E BLUEBERRY ST, MERIDIAN, ID 83642-8261
(208) 775-7418
(208) 674-5008
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/07/2024
Last updated
02/07/2024
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