Organization Active NPI

Triquetra Therapy Services, LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Belen, NM
National Provider Identifier
1376185488
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
TRIQUETRA THERAPY SERVICES, LLC
Practice address
19478 Highway 314
Belen, NM 87002-8223
Phone
(505) 357-4385
Fax
(505) 212-0642
NPI assigned
Oct 9, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Dr. Denai Forrest, DNP, CNP, PMHNP-BCNPI 1447734165
Title
Pmhnp-BC
Phone
(505) 357-4385

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

19478 Highway 314
Belen, NM 87002-8223

Mailing address

1224 Silva Rd
Belen, NM 87002-7563
Phone (505) 314-4966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191219000255 NM Part B Supplier - Clinic/Group Practice 1456785740 Receives reassigned benefits from 1 practitioner
Practice locations: Belen, NM

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1570579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1376185488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1224 SILVA RD",
            "city": "BELEN",
            "state": "NM",
            "postal_code": "870027563",
            "telephone_number": "505-314-4966",
            "fax_number": "505-212-0642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19478 HIGHWAY 314",
            "city": "BELEN",
            "state": "NM",
            "postal_code": "870028223",
            "telephone_number": "505-357-4385",
            "fax_number": "505-212-0642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIQUETRA THERAPY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-09",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "FORREST",
        "authorized_official_first_name": "DENAI",
        "authorized_official_title_or_position": "PMHNP-BC",
        "authorized_official_telephone_number": "505-357-4385",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, CNP, PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belen, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.