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General NPI Number Information
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NPI Number | 1629558838
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Entity Type | Organization
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Legal Business Name | OCOTILLO PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 2801 MISSOURI AVE STE 36
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City | LAS CRUCES
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State | NM
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Zip | 88011-9151
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Country | US
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Telephone | 575-635-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 1830 MYRTLE AVE
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City | LAS CRUCES
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State | NM
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Zip | 88001-5245
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Country | US
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Telephone | 575-635-2002
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | DR. TRACIE HITTER
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Credential | PH.D.
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Telephone | 575-635-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY1460
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License Number State | NM
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