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General NPI Number Information
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NPI Number | 1558856104
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Entity Type | Organization
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Legal Business Name | DAYBREAK COUNSELING, INC.
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 4001 OFFICE COURT DR STE 403
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City | SANTA FE
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State | NM
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Zip | 87507-4906
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Country | US
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Telephone | 505-395-9456
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Fax | 505-930-5114
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Provider Business Mailing Address
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Address Line | 4001 OFFICE COURT DR STE 302
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City | SANTA FE
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State | NM
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Zip | 87507-4930
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Country | US
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Telephone | 505-395-9456
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Fax | 505-930-5114
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | HAL AGLER
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Credential | LCSW
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Telephone | 505-395-9456
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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 | C-08163
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License Number State | NM
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