MEDICARE: EL PASO MENTAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	101Y00000X	Counselor
3	2084P0800X	Psychiatry Physician
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1184881724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO MENTAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	9440 VISCOUNT STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925
Country	:	US
Telephone Number	:	915-249-6639
Fax Number	:	915-249-6695

Provider Business Practice Location Address
First Line	:	9440 VISCOUNT BLVD STE 100
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-7054
Country	:	US
Telephone Number	:	915-383-1401
Fax Number	:	915-533-2568

Authorized Official
Title or Position	:	PRESIDENT
Name	:	REY LEAL
Credential	:	PMHNP-BC
Telephone Number	:	915-249-6639

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	03/22/2021

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Directions to “EL PASO MENTAL HEALTH, LLC ” Practice Location

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