Healthcare Provider Details

I. General information

NPI: 1366228819
Provider Name (Legal Business Name): DESERT THERAPY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LOS NOGALES DR
LAS CRUCES NM
88001-7408
US

IV. Provider business mailing address

115 LOS NOGALES DR
LAS CRUCES NM
88001-7408
US

V. Phone/Fax

Practice location:
  • Phone: 703-350-1191
  • Fax: 703-350-1191
Mailing address:
  • Phone: 703-350-1191
  • Fax: 703-350-1191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ELIZABETH HARVEY ABRAMS
Title or Position: SOLE MEMBER
Credential: LPCC, NCC
Phone: 703-350-1191