Healthcare Provider Details

I. General information

NPI: 1922399880
Provider Name (Legal Business Name): CENTRAL NEW MEXICO COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 SUN RANCH VILLAGE LOOP SW
LOS LUNAS NM
87031-4869
US

IV. Provider business mailing address

526 SUN RANCH VILLAGE LOOP SW
LOS LUNAS NM
87031-4869
US

V. Phone/Fax

Practice location:
  • Phone: 505-615-0240
  • Fax: 505-869-0645
Mailing address:
  • Phone: 505-615-0240
  • Fax: 505-869-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0093331
License Number StateNM

VIII. Authorized Official

Name: MR. JAMES ANDREW HATFIELD
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: MA, LPCC
Phone: 505-615-0240