1710684154 NPI number — NEW MEXICO CRISIS COUNSELING LLC

Table of content: MAYELIN PACHECO NUNEZ NP (NPI 1013638584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710684154 NPI number — NEW MEXICO CRISIS COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO CRISIS COUNSELING 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:
1710684154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2676 MARICOPA DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIO RANCHO
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87124-3948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-225-2996
Provider Business Mailing Address Fax Number:
505-213-7303

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2676 MARICOPA DR SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87124-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-903-6309
Provider Business Practice Location Address Fax Number:
505-672-7769
Provider Enumeration Date:
02/15/2023

Additional Information

Authorized Official

Authorized Official Last Name:
PORTER
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-225-2996

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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