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General NPI Number Information
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NPI Number | 1326574021
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Entity Type | Organization
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Legal Business Name | 7 CIRCLES JUSTICE CENTER
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Dates
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Enumeration Date | 05/02/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 127 BRIDGE ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-3426
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Country | US
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Telephone | 505-425-9477
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Fax |
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Provider Business Mailing Address
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Address Line | 127 BRIDGE ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-3426
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Country | US
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Telephone | 505-425-9477
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | CHELSEA GUTIERREZ
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Credential | LCSW
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Telephone | 505-425-9477
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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 | C09343
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | C09343
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License Number State | NM
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