MEDICARE: RISING SUN HOLISTIC COUNSELING

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	251S00000X	Community/Behavioral Health Agency	I-3048	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	:	1477897759
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING SUN HOLISTIC COUNSELING

Provider Business Mailing Address
First Line	:	742 STAGECOACH DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8034
Country	:	US
Telephone Number	:	575-571-9980
Fax Number	:	575-522-8907

Provider Business Practice Location Address
First Line	:	742 STAGECOACH DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8034
Country	:	US
Telephone Number	:	575-571-9980
Fax Number	:	575-522-8907

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER/ OWNER
Name	:	MS. JOSEFA PEREA
Credential	:	LISW
Telephone Number	:	575-571-9980

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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Directions to “RISING SUN HOLISTIC COUNSELING ” Practice Location

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