MEDICARE: ESPERANZA GUIDANCE SERVICE INC

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	101YM0800X	Mental Health Counselor	0100941	NM
2	1041C0700X	Clinical Social Worker	M-06372	NM
3	1041C0700X	Clinical Social Worker	I-3133	NM

General Provider Information

NPI Number	:	1750586442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESPERANZA GUIDANCE SERVICE INC

Provider Business Mailing Address
First Line	:	1401 S DON ROSER DR STE A2
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4567
Country	:	US
Telephone Number	:	575-522-5144
Fax Number	:	575-522-5177

Provider Business Practice Location Address
First Line	:	1401 S DON ROSER DR STE A2
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4567
Country	:	US
Telephone Number	:	575-522-5144
Fax Number	:	575-522-5177

Authorized Official
Title or Position	:	CEO, CLINICAL DIRECTOR
Name	:	MRS. RACHEL VILLALOBOS MADEWELL
Credential	:	LISW
Telephone Number	:	575-522-5144

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	12/04/2008

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Directions to “ESPERANZA GUIDANCE SERVICE INC ” Practice Location

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