MEDICARE: EASTERN SLOPE COUNSELING AND CONSULTING, 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	101YM0800X	Mental Health Counselor

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	:	1720592538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN SLOPE COUNSELING AND CONSULTING, LLC

Provider Business Mailing Address
First Line	:	12056 STATE HIGHWAY 14 N
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9405
Country	:	US
Telephone Number	:	505-286-6112
Fax Number	:	505-286-6112

Provider Business Practice Location Address
First Line	:	12126 STATE HIGHWAY 14 N STE E
Second Line	:
City	:	CEDAR CREST
State	:	NM
Zip	:	87008-9406
Country	:	US
Telephone Number	:	505-286-6112
Fax Number	:	505-286-6112

Authorized Official
Title or Position	:	MANAGER/OWNER/COUNSELOR
Name	:	MR. RICHARD LEWIS PATNAUDE
Credential	:	LPCC
Telephone Number	:	505-286-6112

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	06/16/2018

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