Healthcare Provider Details

I. General information

NPI: 1326574021
Provider Name (Legal Business Name): 7 CIRCLES JUSTICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 BRIDGE ST
LAS VEGAS NM
87701-3426
US

IV. Provider business mailing address

127 BRIDGE ST
LAS VEGAS NM
87701-3426
US

V. Phone/Fax

Practice location:
  • Phone: 505-425-9477
  • Fax:
Mailing address:
  • Phone: 505-425-9477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC09343
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberC09343
License Number StateNM

VIII. Authorized Official

Name: CHELSEA GUTIERREZ
Title or Position: SOCIAL WORKER
Credential: LCSW
Phone: 505-425-9477