Healthcare Provider Details

I. General information

NPI: 1992733794
Provider Name (Legal Business Name): OMAR TORRES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 LIVINGSTON LOOP STE C1
SANTA TERESA NM
88008-9753
US

IV. Provider business mailing address

1001 MONTANA AVE
EL PASO TX
79902-5411
US

V. Phone/Fax

Practice location:
  • Phone: 575-824-9000
  • Fax: 866-232-9241
Mailing address:
  • Phone: 915-534-7227
  • Fax: 915-544-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09288
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27442
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: