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General NPI Number Information
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NPI Number | 1649987496
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Entity Type | Organization
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Legal Business Name | CONCHO VALLEY CENTER FOR HUMAN ADVANCEMENT
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Dates
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Enumeration Date | 11/01/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 202 N MAIN ST
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City | SAN ANGELO
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State | TX
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Zip | 76903-4842
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Country | US
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Telephone | 325-658-7750
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Fax |
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Provider Business Mailing Address
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Address Line | 1501 W BEAUREGARD AVE
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City | SAN ANGELO
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State | TX
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Zip | 76901-4004
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Country | US
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Telephone | 325-658-7750
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GREGORY ROWE
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Credential |
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Telephone | 325-658-7750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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