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General NPI Number Information
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NPI Number | 1215363536
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Entity Type | Organization
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Legal Business Name | RX PSYCHOLOGICAL SERVICES, LLC
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Dates
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Enumeration Date | 09/18/2013
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 5300 MCNUTT RD SUITE 12
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City | SANTA TERESA
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State | NM
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Zip | 88008-9606
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Country | US
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Telephone | 575-332-9138
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Fax | 915-231-6111
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Provider Business Mailing Address
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Address Line | 708 ROSINANTE RD
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City | EL PASO
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State | TX
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Zip | 79922-2904
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Country | US
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Telephone | 915-588-0223
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Fax | 915-231-6111
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Authorized Official
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Title or Position | PSYCHOLOGIST/CEO
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Name | JENNIFER ANN DARAKJY
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Credential | PHD
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Telephone | 915-588-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1267
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License Number State | NM
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