MEDICARE: COUNSELING LAS CRUCES, 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
1	106H00000X	Marriage & Family Therapist	0157951	NM

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	:	1194107060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING LAS CRUCES, LLC

Provider Business Mailing Address
First Line	:	530 N CHURCH ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3440
Country	:	US
Telephone Number	:	575-526-9878
Fax Number	:	575-526-7835

Provider Business Practice Location Address
First Line	:	530 N CHURCH ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3440
Country	:	US
Telephone Number	:	575-526-9878
Fax Number	:	575-526-7835

Authorized Official
Title or Position	:	OWNER
Name	:	ANDREA DRESSER
Credential	:	LMFT, CST
Telephone Number	:	575-448-1350

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	07/13/2022

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