Provider Demographics
NPI:1902269061
Name:ANXIETY TREATMENT CENTER OF THE SOUTHWEST
Entity Type:Organization
Organization Name:ANXIETY TREATMENT CENTER OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:575-405-7992
Mailing Address - Street 1:PO BOX 1406
Mailing Address - Street 2:
Mailing Address - City:FAIRACRES
Mailing Address - State:NM
Mailing Address - Zip Code:88033-1406
Mailing Address - Country:US
Mailing Address - Phone:575-405-7992
Mailing Address - Fax:575-527-1689
Practice Address - Street 1:1730 TIERRA DE MESILLA
Practice Address - Street 2:
Practice Address - City:MESILLA
Practice Address - State:NM
Practice Address - Zip Code:88046
Practice Address - Country:US
Practice Address - Phone:575-405-7992
Practice Address - Fax:575-527-1689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0104991106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM96188251Medicaid