Healthcare Provider Details

I. General information

NPI: 1205978319
Provider Name (Legal Business Name): EL PASO COUNSELING CENTER OF EXPRESSIVE ARTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR SUITE B1
EL PASO TX
79902-5002
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE B1
EL PASO TX
79902-5002
US

V. Phone/Fax

Practice location:
  • Phone: 915-845-3122
  • Fax: 915-845-4165
Mailing address:
  • Phone: 915-845-3122
  • Fax: 915-845-4165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: LEAH MILLER
Title or Position: OWNER
Credential: LPC-S, LMFT, RPT-S
Phone: 915-845-3122