MEDICARE: 7 CIRCLES JUSTICE CENTER

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	251S00000X	Community/Behavioral Health Agency	C09343	NM
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	C09343	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326574021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	7 CIRCLES JUSTICE CENTER

Provider Business Mailing Address
First Line	:	127 BRIDGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3426
Country	:	US
Telephone Number	:	505-425-9477
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 BRIDGE ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3426
Country	:	US
Telephone Number	:	505-425-9477
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	CHELSEA GUTIERREZ
Credential	:	LCSW
Telephone Number	:	505-425-9477

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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