Organization
MENTAL HEALTH WELLNESS CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILL LAFRENIERE (CREDENTIALING MANAGER)
(575) 532-1888
Entity
Organization
Contact information
Practice address
3855 FOOTHILLS RD STE C, LAS CRUCES, NM 88011
(575) 520-2861
(575) 652-4937
Mailing address
3855 FOOTHILLS RD STE C, LAS CRUCES, NM 88011-4772
(575) 520-2861
(575) 652-4937
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53627580
—
NM
Enumeration date
01/30/2017
Last updated
01/15/2020
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