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General NPI Number Information
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NPI Number | 1487461497
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Entity Type | Organization
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Legal Business Name | LA RAZA SERVICES, INC.
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 805 W 4TH ST
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City | PUEBLO
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State | CO
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Zip | 81003-2305
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Country | US
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Telephone | 719-359-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 W 14TH AVE
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City | DENVER
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State | CO
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Zip | 80204-2203
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Country | US
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Telephone | 303-458-5851
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | RICKY LYNN THOMPSON
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Credential | LCSW, LAC
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Telephone | 720-591-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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