Healthcare Provider Details

I. General information

NPI: 1275899684
Provider Name (Legal Business Name): EUGENE I HINOJOS JR. LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EUGENE HINOJOS JR. LMSW., LADAC

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 WEST HIGHWAY 66
GRANTS NM
87020
US

IV. Provider business mailing address

2595 WEST HIGHWAY 66
GRANTS NM
87020
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-5451
  • Fax: 505-285-6436
Mailing address:
  • Phone: 505-285-5451
  • Fax: 505-285-6436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberM-07609
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-08547
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0141591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: