Healthcare Provider Details

I. General information

NPI: 1871338640
Provider Name (Legal Business Name): TRICOUNTY FAMILY JUSTICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 06/26/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2534 RIDGE RUNNER ROAD
LAS VEGAS NM
87701
US

IV. Provider business mailing address

2534 RIDGE RUNNER ROAD
LAS VEGAS NM
87701
US

V. Phone/Fax

Practice location:
  • Phone: 505-718-7330
  • Fax: 505-718-7373
Mailing address:
  • Phone: 505-718-7330
  • Fax: 505-718-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: TERRI LEE PEARCE
Title or Position: EXECUTIVE DIRECTOR
Credential: LMSW
Phone: 505-718-7300