Healthcare Provider Details

I. General information

NPI: 1043729007
Provider Name (Legal Business Name): IVAN NOE TORRES LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 09/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 MERIDA DR
ANTHONY NM
88021-8225
US

IV. Provider business mailing address

945 S MESA HILLS DR APT 3215
EL PASO TX
79912-5197
US

V. Phone/Fax

Practice location:
  • Phone: 575-649-9327
  • Fax:
Mailing address:
  • Phone: 915-491-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0191561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: