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General NPI Number Information
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NPI Number | 1093080269
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Entity Type | Organization
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Legal Business Name | BIENESTAR FAMILY COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 4950 MCNUTT RD
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City | SANTA TERESA
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State | NM
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Zip | 88008-9621
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Country | US
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Telephone | 915-203-5103
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Fax | 575-541-3669
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Provider Business Mailing Address
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Address Line | PO BOX 1137
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City | SANTA TERESA
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State | NM
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Zip | 88008-1137
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Country | US
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Telephone | 915-203-5103
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Fax | 575-541-3669
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIRIAM RIVAS
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Credential | LPCC
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Telephone | 915-203-5103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0128131
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License Number State | NM
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