| Birch Trail, Llc | |
|
210 Plaza St Las Vegas NM 87701-3433 | |
| (505) 426-7052 | |
| Not Available |
| Full Name | Birch Trail, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 210 Plaza St, Las Vegas, New Mexico |
| Authorized Official Name and Position | Melissa Williamson (OWNER) |
| Authorized Official Contact | 5057182472 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Birch Trail, Llc 600 Washington St Las Vegas NM 87701-4235 Ph: (505) 718-2472 | Birch Trail, Llc 210 Plaza St Las Vegas NM 87701-3433 Ph: (505) 426-7052 |
| NPI Number | 1639797483 |
|---|---|
| Provider Enumeration Date | 07/08/2020 |
| Last Update Date | 08/01/2020 |
| Certification Date | 08/01/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639797483 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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