Organization
CYFD-STATE OF NEW MEXICO-TCM
Active
Other names
Targeted Case Management
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG NELSON (BUREAU CHIEF, CYFDJJS)
(505) 331-8562
Entity
Organization
Contact information
Practice address
4000 EDITH BLVD NE, ALBUQUERQUE, NM 87107-2222
(505) 841-2400
Mailing address
4000 EDITH BLVD NE, ALBUQUERQUE, NM 87107-2222
(505) 331-8562
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
172V00000X
Community Health Worker
—
—
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
251B00000X
Case Management Agency
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74475
—
NM
Enumeration date
11/28/2006
Last updated
07/14/2025
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