Healthcare Provider Details

I. General information

NPI: 1063348712
Provider Name (Legal Business Name): BEACON THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E IDAHO AVE ST 2B
LAS CRUCES NM
88001
US

IV. Provider business mailing address

715 E IDAHO AVE ST 2B
LAS CRUCES NM
88001
US

V. Phone/Fax

Practice location:
  • Phone: 575-448-1503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MADISON J DURAN
Title or Position: FOUNDER
Credential: LCSW, RPT
Phone: 575-448-1503