Telemental Health Link LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

TELEMENTAL HEALTH LINK LLC

Doing business as

Telemental Health Link -NM
THL New Mexico
Telemental Health Link New Mexico

Practice address

5700 Harper Dr NE Ste 210-4
Albuquerque, NM 87109-3573

Phone

(208) 775-7418

Fax

(208) 768-4500

NPI assigned

Feb 7, 2024

Last updated

Feb 7, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

TELEMENTAL HEALTH LINK LLCAs reported in NPPES

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

Authorized official

Name

Susan M Derivas, PMHNP-BCNPI 1851493829

Title

Ao

Phone

(208) 775-7418

Specialties & licenses 2

Addresses

Other names 3

• TELEMENTAL HEALTH LINK -NM Doing business as
• THL New Mexico Doing business as
• Telemental Health Link New Mexico Doing business as

Part of

Telemental Health Link LLC

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan M Derivas, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Meridian, ID
  • NPI 1851493829

  Multi-Specialty

  NPD Authorized official

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

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1972367290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 E BLUEBERRY ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836428261",
            "telephone_number": "208-775-7418",
            "fax_number": "208-674-5008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 HARPER DR NE STE 210-4",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093573",
            "telephone_number": "208-775-7418",
            "fax_number": "208-768-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4055 E Blueberry St",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836428261",
            "country_code": "US",
            "telephone_number": "208-600-2060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TELEMENTAL HEALTH LINK LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TELEMENTAL HEALTH LINK LLC",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "DERIVAS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "208-775-7418",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TELEMENTAL HEALTH LINK -NM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THL New Mexico",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Telemental Health Link New Mexico",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joel R Teicher, MD
• Joao Pedro Teixeira, M.D.
• Jennifer Tejada, LM, CPM
• Ahmed Telbany, M.D., M.P.H
• Telemd Health Southwest LLC
• Robert Telepak
• Telepsych 4 You, LLC
• Stephanie Anne Telge, M.S., CCC-SLP
• Arcineh Telime, MS, BCBA
• Caroline Telles

• Psychiatric/Mental Health Nurse Practitioner in Albuquerque, NM
• Providers in Albuquerque, 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 Feb 7, 2024; 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.