| Desert Mountain Healing Iop | |
|
3301 Southern Blvd Se Ste 105 Rio Rancho NM 87124-5859 | |
| (505) 270-0840 | |
| Not Available |
| Full Name | Desert Mountain Healing Iop |
|---|---|
| Speciality | Counselor |
| Location | 3301 Southern Blvd Se Ste 105, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Sean Roberts (COOWNER) |
| Authorized Official Contact | 5052700840 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Mountain Healing Iop 3301 Southern Blvd Se Ste 105 Rio Rancho NM 87124-5859 Ph: (505) 270-0840 | Desert Mountain Healing Iop 3301 Southern Blvd Se Ste 105 Rio Rancho NM 87124-5859 Ph: (505) 270-0840 |
| NPI Number | 1831830413 |
|---|---|
| Provider Enumeration Date | 04/06/2022 |
| Last Update Date | 11/30/2023 |
| Certification Date | 11/30/2023 |
| Medicare PECOS PAC ID | 9931562923 |
|---|---|
| Medicare Enrollment ID | O20231103001299 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831830413 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
| Provider Name | Charles W Bennett |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1548452915 PECOS PAC ID: 9335233188 Enrollment ID: I20180702002069 |
| Provider Name | Regina L Largent |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609111004 PECOS PAC ID: 7911356548 Enrollment ID: I20231207004181 |
| Provider Name | Robert B Galligan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578771929 PECOS PAC ID: 4880034891 Enrollment ID: I20240424001985 |
| Provider Name | Jennifer Amanda Barela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831954841 PECOS PAC ID: 9133560766 Enrollment ID: I20240514003598 |
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