MEDICARE: ANGELS NETWORK COUNSELING SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1104478858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGELS NETWORK COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	811 E AMADOR AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3378
Country	:	US
Telephone Number	:	575-312-2348
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 E AMADOR AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3378
Country	:	US
Telephone Number	:	575-312-2348
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	MARIA BAGWELL
Credential	:
Telephone Number	:	575-312-2348

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	10/25/2024

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