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Organization

SOUTHEAST MENTAL HEALTH SERVICES

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISA CHAVEZ (CONTRACT AND CREDENTIALING MANAGER)
(719) 383-5448
Entity
Organization

Contact information

Practice address
711 BARNES AVE, LA JUNTA, CO 81050-2138
(719) 384-5446
Mailing address
711 BARNES AVE, LA JUNTA, CO 81050-2138

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9000176853
CO
Enumeration date
01/05/2021
Last updated
09/13/2022
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