Mimbres Psychological Services

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

Legal business name

MIMBRES PSYCHOLOGICAL SERVICES

Practice address

2811 Indian School Rd NE
Albuquerque, NM 87106-1825

Phone

(505) 358-0087

NPI assigned

Jan 19, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miriam Whittam

Title

Practice Manager

Phone

(505) 358-0087

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1104578319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 INDIAN SCHOOL RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061825",
            "telephone_number": "505-358-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 INDIAN SCHOOL RD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871061825",
            "telephone_number": "505-358-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIMBRES PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "WHITTAM",
        "authorized_official_first_name": "MIRIAM",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "505-358-0087"
    },
    "taxonomies": [
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dallin Milne, DMD
• Robert L Milne, MD
• Lucas Miltenberger, CNP
• Scott Miltenburger, DMD
• Milton C. Lasoski, PH.D, LLC
• Mimo Health and Wellness LLC
• Caleb Mims
• Karin Corinna Mims
• Hiroko Minami, LMHC
• Jennifer Rebecca Minarsich-Noble, MA

• Adolescent and Children Mental Health Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Adolescent and Children Mental Health Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.