MEDICARE: LIBERA BEHAVIORAL HEALTH CENTER

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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1124632625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERA BEHAVIORAL HEALTH CENTER

Provider Business Mailing Address
First Line	:	3249 MANNY AGUILERA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-2760
Country	:	US
Telephone Number	:	832-998-7387
Fax Number	:	832-200-3005

Provider Business Practice Location Address
First Line	:	3249 MANNY AGUILERA DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-2760
Country	:	US
Telephone Number	:	832-998-7387
Fax Number	:	832-200-3005

Authorized Official
Title or Position	:	OWNER
Name	:	ROSALINA RUIZ
Credential	:	LPC
Telephone Number	:	281-688-5060

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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