Healthcare Provider Details

I. General information

NPI: 1518452945
Provider Name (Legal Business Name): CONNECTIONS THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E IDAHO AVE STE 25
LAS CRUCES NM
88005-3242
US

IV. Provider business mailing address

225 E IDAHO AVE STE 25
LAS CRUCES NM
88005-3242
US

V. Phone/Fax

Practice location:
  • Phone: 575-571-1016
  • Fax:
Mailing address:
  • Phone: 575-571-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHARLES GATES
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 575-571-1016