Healthcare Provider Details

I. General information

NPI: 1740716471
Provider Name (Legal Business Name): COREY VAS COUNSELING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 N ALAMEDA BLVD STE 6
LAS CRUCES NM
88005-2172
US

IV. Provider business mailing address

741 N ALAMEDA BLVD STE 6
LAS CRUCES NM
88005-2172
US

V. Phone/Fax

Practice location:
  • Phone: 575-496-2616
  • Fax: 575-571-4483
Mailing address:
  • Phone: 575-496-2616
  • Fax: 575-571-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0844
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0844
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0844
License Number StateNM

VIII. Authorized Official

Name: COREY J. VAS
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 575-496-2616