Healthcare Provider Details

I. General information

NPI: 1407912785
Provider Name (Legal Business Name): VALENCIA COUNSELING SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 DON PASQUAL RD NW
LOS LUNAS NM
87031-8493
US

IV. Provider business mailing address

735 DON PASQUAL RD NW
LOS LUNAS NM
87031-8493
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax: 505-865-4739
Mailing address:
  • Phone: 505-865-3350
  • Fax: 505-865-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. SAM VIGIL
Title or Position: CEO
Credential:
Phone: 505-864-3350