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General NPI Number Information
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NPI Number | 1851884423
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Entity Type | Organization
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Legal Business Name | NUEVA VIDA COUNSELING AND CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | NUEVA VIDA COUNSELING & CONSULTING SERVICES LLC 1920 7TH STREET
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City | LAS VEGAS
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State | NM
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Zip | 87701
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Country | US
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Telephone | 505-429-0905
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Fax | 505-425-2913
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Provider Business Mailing Address
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Address Line | NUEVA VIDA COUNSELING & CONSULTING SERVICES LLC 1920 7TH STREET
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City | LAS VEGAS
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State | NM
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Zip | 87701
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Country | US
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Telephone | 505-429-0905
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Fax | 505-425-2913
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Authorized Official
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Title or Position | OWNER & MENTAL HEALTH PRACTITIONER
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Name | DR. JOHN MICHAEL TOURANGEAU
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Credential | LADAC, LCSW, PHD
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Telephone | 505-429-0905
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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-4248
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License Number State | NM
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