1497947519 NPI number — ALAMOGORDO COUNSELING ASSOCIATES, LLC

Table of content: (NPI 1497947519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497947519 NPI number — ALAMOGORDO COUNSELING ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMOGORDO COUNSELING ASSOCIATES, 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:
1497947519
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 CAMINO REAL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALAMOGORDO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88310-7834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-443-6166
Provider Business Mailing Address Fax Number:
575-437-0755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N WHITE SANDS BLVD
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-6774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-443-6166
Provider Business Practice Location Address Fax Number:
575-437-0755
Provider Enumeration Date:
08/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GILSDORF
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
575-443-6166

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  0096281 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com