Healthcare Provider Details

I. General information

NPI: 1225757628
Provider Name (Legal Business Name): MOLINA INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 06/12/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GOLDEN KEY CIR STE 121
EL PASO TX
79925-5813
US

IV. Provider business mailing address

12649 KATHERINE BRENNAND RD
EL PASO TX
79928-5892
US

V. Phone/Fax

Practice location:
  • Phone: 915-500-0944
  • Fax: 915-201-0944
Mailing address:
  • Phone: 915-217-4648
  • Fax: 915-201-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: CARMEN MOLINA
Title or Position: OWNER
Credential: BCBA, LPC-S
Phone: 915-217-4648