Healthcare Provider Details

I. General information

NPI: 1952065831
Provider Name (Legal Business Name): TACY RENE PERKINS LPCC LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S DON ROSER DR STE E-3
LAS CRUCES NM
88011-4567
US

IV. Provider business mailing address

1909 CUBA AVE STE 5
ALAMOGORDO NM
88310-5646
US

V. Phone/Fax

Practice location:
  • Phone: 575-489-4616
  • Fax: 575-489-4619
Mailing address:
  • Phone: 575-489-4616
  • Fax: 575-489-4619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAD0220931
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB20250926
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: