Organization
CORAZON BEHAVIORAL HEALTH SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REVA LEE HERON PHD (EXECUTIVE DIRECTOR)
(505) 662-3600
Entity
Organization
Contact information
Practice address
1362 C TRINITY DRIVE, LOS ALAMOS, NM 87544
(505) 662-3600
(505) 662-0937
Mailing address
1362 C TRINITY DRIVE, LOS ALAMOS, NM 87544
(505) 662-3600
(505) 662-0937
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G9368
—
NM
Enumeration date
11/14/2006
Last updated
08/22/2020
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