Healthcare Provider Details

I. General information

NPI: 1245733583
Provider Name (Legal Business Name): PRACTICAL SOLUTIONS ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 COMMERCE WAY STE 6
CLOVIS NM
88101-4870
US

IV. Provider business mailing address

PO BOX 640
CLOVIS NM
88102-0640
US

V. Phone/Fax

Practice location:
  • Phone: 575-208-0028
  • Fax: 575-680-1075
Mailing address:
  • Phone: 575-208-0028
  • Fax: 575-680-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIO CHAVEZ
Title or Position: OWNER
Credential: LPCC
Phone: 575-208-0028