MEDICARE: REGIONAL EDUCATIONAL CENTER #6

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	NM
2	390200000X	Student in an Organized Health Care Education/Training Program	NM
3	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144575044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL EDUCATIONAL CENTER #6

Provider Business Mailing Address
First Line	:	PO BOX 847
Second Line	:
City	:	PORTALES
State	:	NM
Zip	:	88130-0847
Country	:	US
Telephone Number	:	575-562-4455
Fax Number	:	575-562-4460

Provider Business Practice Location Address
First Line	:	7TH & ELM STREET
Second Line	:
City	:	SAN JON
State	:	NM
Zip	:	88434
Country	:	US
Telephone Number	:	575-576-2273
Fax Number	:	575-576-2273

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PATTI HARRELSON
Credential	:
Telephone Number	:	575-562-4455

Provider Enumeration Date	:	07/17/2012
Last Update Date	:	07/17/2012

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Directions to “REGIONAL EDUCATIONAL CENTER #6 ” Practice Location

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