Healthcare Provider Details

I. General information

NPI: 1912110453
Provider Name (Legal Business Name): UKEP MONTWOOD CAMPUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11150 MONTWOOD DRIVE BUILDING A
EL PASO TX
79936-4240
US

IV. Provider business mailing address

11150 MONTWOOD DRIVE BUILDING A
EL PASO TX
79936-4240
US

V. Phone/Fax

Practice location:
  • Phone: 915-591-2101
  • Fax: 915-591-2116
Mailing address:
  • Phone: 915-591-2101
  • Fax: 915-591-2116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12497
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number9101
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19422
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCERTIFICATION
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number08025063
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18407
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberM 5181
License Number StateTX

VIII. Authorized Official

Name: MS. LOURDES LUNA
Title or Position: OWNER DIRECTOR
Credential:
Phone: 915-591-2101