Organization
BIRCH TRAIL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA WILLIAMSON LCSW (OWNER)
(505) 718-2472
Entity
Organization
Contact information
Practice address
210 PLAZA ST, LAS VEGAS, NM 87701-3433
(505) 426-7052
Mailing address
600 WASHINGTON ST, LAS VEGAS, NM 87701-4235
(505) 718-2472
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
07/08/2020
Last updated
08/01/2020
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