1073702551 NPI number — DESERT SKY COUNSELING SERVICES LLC

Table of content: (NPI 1073702551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073702551 NPI number — DESERT SKY COUNSELING SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DESERT SKY COUNSELING SERVICES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073702551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W BOUTZ RD
Provider Second Line Business Mailing Address:
BLDG. 8 STE. 1
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88005-3262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-521-4555
Provider Business Mailing Address Fax Number:
575-521-1169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 W BOUTZ RD
Provider Second Line Business Practice Location Address:
BLDG. 8 SUITE 1
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88005-3262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-521-4555
Provider Business Practice Location Address Fax Number:
575-521-1169
Provider Enumeration Date:
10/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LYNCH
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
575-521-4555

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 92875246 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com