Organization
BAIR FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE MICKOLIC LSW (EXECUTIVE DIRECTOR)
(724) 946-8711
Entity
Organization
Contact information
Practice address
755 S TELSHOR BLVD STE 109-D, LAS CRUCES, NM 88011-4688
(575) 647-1604
Mailing address
755 S TELSHOR BLVD STE 109-D, LAS CRUCES, NM 88011-4688
(575) 647-1604
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
M-07255
NM
Other
Enumeration date
01/27/2012
Last updated
01/27/2012
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