Healthcare Provider Details

I. General information

NPI: 1679179840
Provider Name (Legal Business Name): PECOS VALLEY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 09/06/2023
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 BECKER AVE
BELEN NM
87002-3634
US

IV. Provider business mailing address

1894 CHAPARRAL LOOP
SOCORRO NM
87801-3718
US

V. Phone/Fax

Practice location:
  • Phone: 575-517-0931
  • Fax: 575-706-9426
Mailing address:
  • Phone: 575-517-0931
  • Fax: 575-706-9426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID L WRIGHT
Title or Position: EXECUTIVE OFFICER
Credential: LMSW
Phone: 575-517-0931