1063682458 NPI number — RIO VISTA COUNSELING

Table of content: (NPI 1063682458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063682458 NPI number — RIO VISTA COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIO VISTA COUNSELING
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:
6
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:
1063682458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8417 WASHINGTON PL NE STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87113-1720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-507-4408
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8417 WASHINGTON PL NE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87113-1720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-507-4408
Provider Business Practice Location Address Fax Number:
505-867-6059
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SPEAKER
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
OWNER/CLINICAL DIRECTOR
Authorized Official Telephone Number:
505-507-4408

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: VNM012413NO , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: VNM012413PS , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: VNM012413OT , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: VNM012413NI , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255457339 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: VNM012413PX , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 35473011 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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