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NPI Code Detail

MEDICARE: CREATING CONNECTIONS COUNSELING SERVICES LLC

MEDICARE: CREATING CONNECTIONS COUNSELING SERVICES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1124594973
Entity Type Code : Organization
Provider Name (Legal Business Name) : CREATING CONNECTIONS COUNSELING SERVICES LLC
Provider Business Mailing Address
First Line : 255 W HADLEY AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-1806
Country : US
Telephone Number : 575-915-4866
Fax Number : 575-993-5361
Provider Business Practice Location Address
First Line : 255 W HADLEY AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-1806
Country : US
Telephone Number : 575-915-4866
Fax Number : 575-993-5361
Authorized Official
Title or Position : BILLING/CREDENTIALING
Name : WILLIAM E LAFRENIERE
Credential :
Telephone Number : 575-635-0407
Provider Enumeration Date : 10/19/2018
Last Update Date : 01/15/2020

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