Healthcare Provider Details

I. General information

NPI: 1780125989
Provider Name (Legal Business Name): RIO RANCHO FAMILY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RIO RANCHO DR NE STE 205
RIO RANCHO NM
87124-1456
US

IV. Provider business mailing address

1340 MONTERREY RD NE
RIO RANCHO NM
87144-1599
US

V. Phone/Fax

Practice location:
  • Phone: 505-814-1460
  • Fax:
Mailing address:
  • Phone: 505-814-1460
  • Fax: 505-985-7433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0145701
License Number StateNM

VIII. Authorized Official

Name: NATALIE CHAVEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-814-1460