Organization
SAN JUAN COLLEGE
Active
Other names
Children's Behavioral Health Program
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE DEHERRERA LMSW (PROGRAM DIRECTOR)
(505) 566-3846
Entity
Organization
Contact information
Practice address
4601 COLLEGE BLVD, FARMINGTON, NM 87402-4609
(505) 566-3846
(505) 566-3687
Mailing address
4601 COLLEGE BLVD, FARMINGTON, NM 87402-4609
(505) 566-3846
(505) 566-3687
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
M-07674
NM
Other
Enumeration date
07/13/2012
Last updated
07/13/2012
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