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General NPI Number Information
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NPI Number | 1003335894
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Entity Type | Organization
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Legal Business Name | BROKEN ARROW COUNSELING SERVICES
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Dates
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Enumeration Date | 09/13/2017
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Last Update Date | 09/26/2017
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Provider Practice Location Address
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Address Line | 840 SIMON LN SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-5908
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Country | US
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Telephone | 505-818-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 4833 MESA PRIETA CT NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-4620
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Country | US
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Telephone | 505-818-7934
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL WILLIAM ROSS
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Credential | LCSW
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Telephone | 505-818-7934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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