Organization
FOUR CORNERS MENTAL AND BEHAVIORAL HEALTH PC
Active
Organization
FOUR CORNERS MENTAL AND BEHAVIORAL HEALTH PC
Active
Other names
FCMBH-PC
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON SOLIS BACA (OFFICE MANAGER)
(505) 200-9855
Entity
Organization
Contact information
Practice address
1003 LUNA CIR NW, ALBUQUERQUE, NM 87102-1973
(505) 504-5505
(505) 214-5614
Mailing address
PO BOX 95602, ALBUQUERQUE, NM 87199
(505) 504-5505
(505) 214-5614
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
106H00000X
Marriage & Family Therapist
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37776825
—
NM
Enumeration date
06/05/2012
Last updated
08/29/2023
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