PRIMARY WELLNESS TEAM CORPORATION (NPI# 1417489378) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417489378 |
| Entity Type | Organization |
| Organization Name | PRIMARY WELLNESS TEAM CORPORATION |
| Other Organization Name | REEF MEDICAL CLINIC |
| Practice Address |
5805 Mcnutt Rd Ste D Santa Teresa NM 88008-8001 |
| Mailing Address |
205 W Boutz Rd Bldg 1 Las Cruces NM 88005-3262 |
| Practice Telephone | 5752651717 |
| Mailing Telephone | 5755327000 |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2017-06-30 |
| Authorized Official Name | CHRISTIAN LIRA (MANAGER) |
| Authorized Official Telephone | 9152023232 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TP0016X |
Psychologist Specialization: Prescribing (Medical) |
Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| Reef Medical Clinic | Doing Business As Name - Organization |
| Street Address |
5805 MCNUTT RD STE D |
| City | SANTA TERESA |
| State | NM |
| Zip Code | 88008-8001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194325308 | Green Minds Matter LLC | Nurse Practitioner | 5805 Mcnutt Rd, Santa Teresa, NM 88008-8001 | 2020-10-27 |
| 1427616259 | Southwest Psychiatry Pllc | Nurse Practitioner | 5805 Mcnutt Rd, Santa Teresa, NM 88008-8001 | 2019-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507211 | Genoa Healthcare, LLC | Durable Medical Equipment & Medical Supplies | 5690 Santa Teresita Drive, Suite A2, Room P1, Santa Teresa, NM 88008 | 2020-10-27 |
| 1891848131 | Direct Healthcare South Inc | Home Health | 101 Livingston Loop, Suite 5, Santa Teresa, NM 88008 | 2007-01-19 |
| 1912061235 | Rio Valle Behavioral Health Centre | Psychiatry & Neurology | 101 Livinston Loop, Bldg C Suite 3, Santa Teresa, NM 88008 | 2006-12-21 |
| 1679634562 | Robert L Nichols | Family Medicine | 1300 Country Club Road, Santa Teresa, NM 88008 | 2006-12-13 |
| 1881792950 | Leo J Raschbaum Mdpc | Clinic/Center | 5690 Santa Teresita, Building A, Suite 4, Santa Teresa, NM 88008 | 2006-09-20 |
| 1366410276 | Emilio T. Rivera | Anesthesiology | 5290 Mcnutt Rd, Ste 109, Santa Teresa, NM 88008 | 2006-03-08 |
| 1225486194 | Diane Rivera | Registered Nurse | 101 Airport Road, Santa Teresa, NM 88008 | 2016-06-01 |
| 1780080358 | Audriana Apodaca | Nurse Practitioner | 100 Airport Rd, Santa Teresa, NM 88008 | 2014-11-10 |
| 1447667001 | Noha Oushy Eissa | Dentist | 103 Livingston Loop Ste B3, Santa Teresa, NM 88008 | 2014-07-16 |
| 1871963017 | Oralia Quezada | Student in an Organized Health Care Education/Training Program | 103 Livingston Loop, Bldg B, Suite 4, Santa Teresa, NM 88008-1063 | 2015-09-30 |
| Find all providers in zip 88008 | ||||
| Taxonomy Code | 103TP0016X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Prescribing (Medical) |
| Those licensed psychologists who have completed specialized, post-doctoral training in psychopharmacology, passed a national proficiency examination in psychopharmacology, and who are authorized by state statute to prescribe medications, in accordance with their state law and state licensing authority, for the evaluation, diagnosis, management and treatment of mental, nervous, emotional, behavioral, and related disorders. |
| Notes: Source: Louisiana Academy of Medical Psychologists Note: Some states issue licenses under Medical Psychologist. [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154877371 | J. Michael Mash Prescribing Psychologist LLC | Psychologist | 4155 State Road 68, Unit 6, Rancho De Taos, NM 87557 | 2016-08-28 |
| 1003218553 | Integrated Healthcare of New Mexico | Psychologist | 7632 William Moyers Ave Ne, Albuquerque, NM 87122-2765 | 2014-09-16 |
| 1124466446 | Shekinah Foundation | Psychologist | 3001 S Wyoming Ave, Roswell, NM 88203-2326 | 2013-06-08 |
| 1902197098 | S M Cobb | Psychologist | 400 N Pennsylvania Ave Ste 990, Roswell, NM 88201-4754 | 2011-04-25 |
| 1730203860 | Pattijo N Velasquez | Psychologist | 1505 S Don Roser Dr, Ste. A, Las Cruces, NM 88011-4596 | 2007-03-16 |
| 1285232397 | Dr Tony J Kreuch LLC | Psychologist | 2204 Brothers Rd Ste B, Santa Fe, NM 87505-6975 | 2020-10-12 |
| 1245856913 | Paul King-miller Psyd Lpcc LLC | Psychologist | 11216 Brentwood Hills Blvd Ne, Albuquerque, NM 87112-3219 | 2020-06-18 |
| 1548677669 | Winds of Change Mental Health Services, LLC | Psychologist | 108 E High St, Grants, NM 87020-2453 | 2014-07-21 |
| 1982024105 | Drw Behavioral Health Services, LLC | Psychologist | 1395 Missouri Ave, Las Cruces, NM 88001-5327 | 2014-04-27 |
| 1477585990 | Deborah Leslie Kos | Psychologist | 4810 Hardware Dr Ne, Albuquerque, NM 87109-2013 | 2006-07-07 |
| Find all providers with the same taxonomy | ||||
| City | SANTA TERESA |
| Zip Code | 88008 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.