Organization
TOTAH BEHAVIORAL HEALTH AUTHORITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
URIAH DIXON SIMPSON (COMMUNITY SUPPORT WORKER)
(505) 564-4804
Entity
Organization
Contact information
Practice address
1615 OJO COURT, FARMINGTON, NM 87401
(505) 564-4804
(505) 564-4857
Mailing address
PO BOX 5190, FARMINGTON, NM 87499-5190
(505) 564-4804
(505) 564-4857
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
115889273
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
115889273
COMMUNITY SUPPORT WORKER
NM
Enumeration date
09/18/2015
Last updated
09/18/2015
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