Healthcare Provider Details

I. General information

NPI: 1770624348
Provider Name (Legal Business Name): POSITIVE OUTCOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 NORTH CALIFORNIA STREET
SOCORRO NM
87801-0642
US

IV. Provider business mailing address

PO BOX 642 1115 NORTH CALIFORNIA STREET
SOCORRO NM
87801-0642
US

V. Phone/Fax

Practice location:
  • Phone: 505-838-0800
  • Fax: 505-838-3999
Mailing address:
  • Phone: 505-838-0800
  • Fax: 505-838-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number006549
License Number StateNM
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1487
License Number StateNM
# 8
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number StateNM
# 9
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MS. TARA JARAMILLO
Title or Position: CEO AND SLP
Credential: MA- CCC- SLP
Phone: 505-838-0800