Provider Demographics
NPI:1245945716
Name:NORTH STAR PSYCHIATRIC SERVICES LLC
Entity type:Organization
Organization Name:NORTH STAR PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-663-6220
Mailing Address - Street 1:NORTH STAR PSYCHIATRIC SERVICES LLC
Mailing Address - Street 2:195 EAST ROAD SUITE 104
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-4301
Mailing Address - Country:US
Mailing Address - Phone:505-412-7756
Mailing Address - Fax:505-662-8859
Practice Address - Street 1:195 EAST ROAD SUITE 104
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4301
Practice Address - Country:US
Practice Address - Phone:505-412-7756
Practice Address - Fax:505-662-8859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM067620752Medicaid