Healthcare Provider Details

I. General information

NPI: 1861852386
Provider Name (Legal Business Name): DIANA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CENTRAL PARK SQ STE 215
LOS ALAMOS NM
87544-4004
US

IV. Provider business mailing address

190 CENTRAL PARK SQ STE 215
LOS ALAMOS NM
87544-4004
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-7585
  • Fax:
Mailing address:
  • Phone: 505-273-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0216881
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0216881
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: