1215363536 NPI number — RX PSYCHOLOGICAL SERVICES, LLC

Table of content: (NPI 1215363536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215363536 NPI number — RX PSYCHOLOGICAL SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RX PSYCHOLOGICAL 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:
1215363536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 ROSINANTE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79922-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-588-0223
Provider Business Mailing Address Fax Number:
915-231-6111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 MCNUTT RD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
SANTA TERESA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88008-9606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-332-9138
Provider Business Practice Location Address Fax Number:
915-231-6111
Provider Enumeration Date:
09/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DARAKJY
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PSYCHOLOGIST/CEO
Authorized Official Telephone Number:
915-588-0223

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  1267 , 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)





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