Healthcare Provider Details

I. General information

NPI: 1285735225
Provider Name (Legal Business Name): HOPE YOUTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 1ST ST SUITE 625
ROSWELL NM
88203-4668
US

IV. Provider business mailing address

200 W 1ST ST SUITE 625
ROSWELL NM
88203-4668
US

V. Phone/Fax

Practice location:
  • Phone: 505-625-6909
  • Fax: 505-625-9442
Mailing address:
  • Phone: 505-625-6909
  • Fax: 505-625-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. LAURI R FOSTER
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 505-625-6909