Provider Demographics
NPI:1023889144
Name:NEW MEXICO PSYCH MED SERVICES, LLC
Entity type:Organization
Organization Name:NEW MEXICO PSYCH MED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENTO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MACP
Authorized Official - Phone:505-218-6383
Mailing Address - Street 1:10242 COORS BYPASS NW # 1020
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4088
Mailing Address - Country:US
Mailing Address - Phone:505-289-0641
Mailing Address - Fax:505-212-4984
Practice Address - Street 1:9652 SUN DANCER DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6089
Practice Address - Country:US
Practice Address - Phone:505-238-5897
Practice Address - Fax:505-212-4984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty