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General NPI Number Information
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NPI Number | 1396391447
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Entity Type | Organization
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Legal Business Name | CONTRERAS COUNSELING, LLC
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 1618 7TH STREET
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City | LAS VEGAS
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State | NM
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Zip | 87701-4920
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Country | US
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Telephone | 505-398-0117
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Fax | 505-425-0701
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Provider Business Mailing Address
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Address Line | 792 DIANE AVE.
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City | LAS VEGAS
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State | NM
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Zip | 87701-4910
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Country | US
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Telephone | 505-398-0117
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Fax | 505-425-0701
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DIANE CONTRERAS
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Credential | LMSW, LPCC
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Telephone | 505-450-4094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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