Healthcare Provider Details

I. General information

NPI: 1386753010
Provider Name (Legal Business Name): DIRECT THERAPY SERVICES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 MED PARK DR
LAS CRUCES NM
88005-3236
US

IV. Provider business mailing address

301 PERKINS DR STE C SUITE C
LAS CRUCES NM
88005-3248
US

V. Phone/Fax

Practice location:
  • Phone: 575-523-7243
  • Fax: 575-525-5641
Mailing address:
  • Phone: 575-523-7243
  • Fax: 575-525-5641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNM

VIII. Authorized Official

Name: BEATRICE SANDOVAL
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-523-7243