Organization
SOUTHEAST MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CHAVEZ (CONTRACT AND CREDENTIALING MANAGER)
(719) 383-5448
Entity
Organization
Contact information
Practice address
437 6TH ST, LAS ANIMAS, CO 81054-1714
(719) 384-5446
(719) 384-5672
Mailing address
711 BARNES AVE, LA JUNTA, CO 81050-2138
(719) 384-5446
(719) 384-5672
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
—
13880063
—
CO
Enumeration date
10/02/2019
Last updated
09/13/2022
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