Mauna Therapy LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

I-06248 Issued in NM

Legal business name

MAUNA THERAPY LLC

Practice address

2507 N Telshor Blvd
Suite A2
Las Cruces, NM 88011-8236

Phone

(575) 521-9210

Fax

(575) 521-9201

NPI assigned

Jun 26, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Amanda Rose Trout, LISW

Title

Owner

Phone

(575) 521-9210

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1245974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245974400000",
    "number": "1427286509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14022",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880134022",
            "telephone_number": "575-521-9210",
            "fax_number": "575-521-9201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 N TELSHOR BLVD",
            "address_2": "SUITE A2",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118236",
            "telephone_number": "575-521-9210",
            "fax_number": "575-521-9201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAUNA THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-26",
        "last_updated": "2009-06-26",
        "status": "A",
        "authorized_official_last_name": "TROUT",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-521-9210",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NM",
            "license": "I-06248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "80137857",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; 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.