Healthcare Provider Details

I. General information

NPI: 1144575044
Provider Name (Legal Business Name): REGIONAL EDUCATIONAL CENTER #6
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7TH & ELM STREET
SAN JON NM
88434
US

IV. Provider business mailing address

PO BOX 847
PORTALES NM
88130-0847
US

V. Phone/Fax

Practice location:
  • Phone: 575-576-2273
  • Fax: 575-576-2273
Mailing address:
  • Phone: 575-562-4455
  • Fax: 575-562-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: PATTI HARRELSON
Title or Position: DIRECTOR
Credential:
Phone: 575-562-4455