Healthcare Provider Details

I. General information

NPI: 1114979747
Provider Name (Legal Business Name): COUNSELING ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MESCALERO
ROSWELL NM
88201
US

IV. Provider business mailing address

PO BOX 1978
ROSWELL NM
88202-1978
US

V. Phone/Fax

Practice location:
  • Phone: 505-623-1480
  • Fax: 505-622-3325
Mailing address:
  • Phone: 505-623-1480
  • Fax: 505-622-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. WAYELENE HALEY
Title or Position: FISCAL OFFICER
Credential:
Phone: 505-623-1480