Organization
SOUTHEAST MENTAL HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CHAVEZ (CONTRACT & CREDENTIALING MANAGER)
(719) 383-5448
Entity
Organization
Contact information
Practice address
122 N. MAIN ST, LAMAR, CO 81052-3901
(719) 384-5446
Mailing address
711 BARNES AVE, LA JUNTA, CO 81050-2138
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
—
9000192972
—
CO
Enumeration date
04/12/2021
Last updated
09/13/2022
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