| Capitan Therapy & Behavioral Health | |
|
102 East Smokey Bear Blvd Capitan NM 88316 | |
| (505) 273-0982 | |
| Not Available |
| Full Name | Capitan Therapy & Behavioral Health |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 102 East Smokey Bear Blvd, Capitan, New Mexico |
| Authorized Official Name and Position | Robert Wudarzewski (OWNER/ ADMINISTRATOR) |
| Authorized Official Contact | 5052730982 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Capitan Therapy & Behavioral Health Po Box 1054 Capitan NM 88316-1054 Ph: (505) 273-0982 | Capitan Therapy & Behavioral Health 102 East Smokey Bear Blvd Capitan NM 88316 Ph: (505) 273-0982 |
| NPI Number | 1790301026 |
|---|---|
| Provider Enumeration Date | 06/23/2020 |
| Last Update Date | 06/23/2020 |
| Certification Date | 06/23/2020 |
| Medicare PECOS PAC ID | 6305262593 |
|---|---|
| Medicare Enrollment ID | O20200818004217 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790301026 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Cheryl Lynne Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598320236 PECOS PAC ID: 2961834163 Enrollment ID: I20191108001166 |
| Provider Name | Kimberly Denise Wudarzewski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720416795 PECOS PAC ID: 5890127021 Enrollment ID: I20191108002415 |
| Provider Name | Misty Gay Mcarthur |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134351513 PECOS PAC ID: 1153725387 Enrollment ID: I20210810000749 |
| Provider Name | Kara L Carthel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447628664 PECOS PAC ID: 0941577910 Enrollment ID: I20230713003958 |