Healthcare Provider Details

I. General information

NPI: 1083874903
Provider Name (Legal Business Name): BREENA S. TAFOYA & ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E IDAHO AVE STE 2E
LAS CRUCES NM
88001-4701
US

IV. Provider business mailing address

715 E IDAHO AVE STE 2E
LAS CRUCES NM
88001-4701
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-9585
  • Fax: 575-556-9456
Mailing address:
  • Phone: 575-556-9585
  • Fax: 575-556-9456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BREENA S. TAFOYA
Title or Position: CEO
Credential:
Phone: 575-556-9585