=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154145340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CREATING NEW FUTURES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3205 TARA ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-5150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-587-9549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3205 TARA ST
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87701-5150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-587-9549
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER
-----------------------------------------------------
Name | DONNA ABREU
-----------------------------------------------------
Credential | LPCC
-----------------------------------------------------
Telephone | 505-587-9549
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------