Sandia Crest Mental Health LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R45675 Issued in NM

Legal business name

SANDIA CREST MENTAL HEALTH LLC

Practice address

1701 US Route 66
Suite D
Moriarty, NM 87035

Phone

(505) 384-1034

NPI assigned

Apr 14, 2008

Last updated

Sep 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Edward Ray Lobaugh, CNS, CNP

Title

Ownder

Phone

(505) 463-2072

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1932373743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3823",
            "city": "MORIARTY",
            "state": "NM",
            "postal_code": "870353823",
            "telephone_number": "505-463-2072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 US ROUTE 66",
            "address_2": "SUITE D",
            "city": "MORIARTY",
            "state": "NM",
            "postal_code": "87035",
            "telephone_number": "505-384-1034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDIA CREST MENTAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-14",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "LOBAUGH",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "OWNDER",
        "authorized_official_telephone_number": "505-463-2072",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CNS, CNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NM",
            "license": "R45675",
            "primary": true
        },
        {
            "code": "364SP0807X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Adolescent",
            "state": "NM",
            "license": "R45675",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Rightsell
• Stephanie Marie Riordan
• Jill Saberhagen-Schorr, CCC-SLP
• Laura E Salem
• Julie Dianne Sanders, RN
• Rebecca Lynn Scheib
• Vashti Jean Schweedler, LPCC
• Megan Servilla
• Yamil Shirley Sotelo
• David Ray Stevens, D.D.S.

• Psychiatric/Mental Health Nurse Practitioner in Moriarty, NM
• Providers in Moriarty, NM by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; 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.