MEDICARE: SOUTHWEST FAMILY GUIDANCE CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	101YP2500X	Professional Counselor
5	103T00000X	Psychologist
6	103TC1900X	Counseling Psychologist
7	1041C0700X	Clinical Social Worker
8	106H00000X	Marriage & Family Therapist
9	251S00000X	Community/Behavioral Health Agency
10	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1184748394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST FAMILY GUIDANCE CENTER LLC

Provider Business Mailing Address
First Line	:	2612 TEXAS ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4684
Country	:	US
Telephone Number	:	505-830-1871
Fax Number	:	505-830-0040

Provider Business Practice Location Address
First Line	:	2612 TEXAS ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4684
Country	:	US
Telephone Number	:	505-830-1871
Fax Number	:	505-830-0040

Authorized Official
Title or Position	:	CHIEF CLINICAL OFFICER
Name	:	DR. CRAIG L PIERCE
Credential	:	PHD
Telephone Number	:	505-830-1781

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	01/17/2024

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