Four Corners Mental and Behavioral Health PC

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

FOUR CORNERS MENTAL AND BEHAVIORAL HEALTH PC

Practice address

1003 Luna Cir NW
Albuquerque, NM 87102-1973

Phone

(505) 504-5505

Fax

(505) 214-5614

NPI assigned

Jun 5, 2012

Organization subpart

No

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

Authorized official

Name

Shannon Solis Baca

Title

Office Manager

Phone

(505) 200-9855

Specialties & licenses 7

Addresses

Other identifiers 1

Other names 1

• FCMBH-PC Other name

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 2

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

• Randolph P Baca Jr., MD

  • Psychiatry Physician
  • Albuquerque, NM
  • NPI 1790982643

  NM, Psychiatry

  Medicare reassignment NPD
• Alejandra Perea, LMHC

  • Mental Health Counselor
  • Los Ranchos, NM
  • NPI 1871061549

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1338854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693267200000",
    "number": "1891056909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95602",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87199",
            "telephone_number": "505-504-5505",
            "fax_number": "505-214-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 LUNA CIR NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871021973",
            "telephone_number": "505-504-5505",
            "fax_number": "505-214-5614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5801 Osuna Rd NE",
            "address_2": "Suite A106",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "87109",
            "country_code": "US",
            "telephone_number": "505-504-5505",
            "fax_number": "505-214-5614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FOUR CORNERS MENTAL AND BEHAVIORAL HEALTH PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-05",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A",
        "authorized_official_last_name": "BACA",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_middle_name": "SOLIS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "505-200-9855"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084B0040X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37776825",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FCMBH-PC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Margaret Mary Foulk, MSW
• Solomon Foulk
• Founders Healthcare LLC
• Founders Healthcare, LLC
• Four Circles Healing, LLC
• Four Humours Healthcare, LLC
• Chloe Davis Fournier-Hall, MD MPH
• Falon Renee Fournier, CNP
• Kayla Ann Kalikokalehua Emiko Fournier, LMT
• Brooke Fourqurean

• All providers in Albuquerque, NM
• Psychiatry Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; 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.