MEDICARE: POSITIVE INNOVATIONS, 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1710472816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POSITIVE INNOVATIONS, LLC

Provider Business Mailing Address
First Line	:	6090 SURETY DR STE 17
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2061
Country	:	US
Telephone Number	:	915-301-0174
Fax Number	:	877-588-3445

Provider Business Practice Location Address
First Line	:	6090 SURETY DR STE 107
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2060
Country	:	US
Telephone Number	:	915-301-0174
Fax Number	:	877-588-3445

Authorized Official
Title or Position	:	CEO
Name	:	DR. NASHUNDA CARR
Credential	:	PSYD
Telephone Number	:	915-301-0174

Provider Enumeration Date	:	06/30/2018
Last Update Date	:	08/14/2020

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Directions to “POSITIVE INNOVATIONS, LLC ” Practice Location

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