Provider Demographics
NPI:1730698309
Name:EQUINE ASSISTED PROGRAMS OF SOUTHERN NEW MEXICO LLC
Entity type:Organization
Organization Name:EQUINE ASSISTED PROGRAMS OF SOUTHERN NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:575-888-7377
Mailing Address - Street 1:1911 TRAILS END RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-6059
Mailing Address - Country:US
Mailing Address - Phone:575-888-7377
Mailing Address - Fax:
Practice Address - Street 1:1911 TRAILS END RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-6059
Practice Address - Country:US
Practice Address - Phone:575-888-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0855X
NM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1073064028Medicaid