Healthcare Provider Details

I. General information

NPI: 1225043904
Provider Name (Legal Business Name): COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/07/2022
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 10TH ST
ALAMOGORDO NM
88310-5053
US

IV. Provider business mailing address

1900 10TH ST
ALAMOGORDO NM
88310-5053
US

V. Phone/Fax

Practice location:
  • Phone: 575-488-2500
  • Fax: 575-488-2502
Mailing address:
  • Phone: 575-488-2500
  • Fax: 575-488-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number3040B1
License Number StateNM

VIII. Authorized Official

Name: MR. LOREN E JACKSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 575-488-2500