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General NPI Number Information
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NPI Number | 1619152238
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Entity Type | Organization
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Legal Business Name | RIO PECOS COUNSELING AND HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 11/03/2008
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Provider Practice Location Address
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Address Line | 608 N CANYON ST
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City | CARLSBAD
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State | NM
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Zip | 88220-5816
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Country | US
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Telephone | 575-234-1644
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Fax | 575-887-2685
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Provider Business Mailing Address
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Address Line | 608 N CANYON ST
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City | CARLSBAD
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State | NM
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Zip | 88220-5816
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Country | US
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Telephone | 575-234-1644
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Fax | 575-887-2685
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JUDY K CARTER
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Credential | LPCC
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Telephone | 575-234-1644
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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 | 0076041
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R57579
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License Number State |
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