Healthcare Provider Details

I. General information

NPI: 1578800934
Provider Name (Legal Business Name): HELENA E. KINTONIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 02/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N UNION AVE
ROSWELL NM
88201-3267
US

IV. Provider business mailing address

PO BOX 2775
ROSWELL NM
88202-2775
US

V. Phone/Fax

Practice location:
  • Phone: 575-637-0020
  • Fax: 575-624-7981
Mailing address:
  • Phone: 575-637-0020
  • Fax: 575-624-7981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0143171
License Number StateNM

VIII. Authorized Official

Name: MS. HELEN KINTONIS
Title or Position: PROFESSIONAL COUNSELOR
Credential: LPCC
Phone: 575-637-0020