1336459411 NPI number — MS. HELEN KINTONIS LPCC

Table of content: MS. HELEN KINTONIS LPCC (NPI 1336459411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336459411 NPI number — MS. HELEN KINTONIS LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINTONIS
Provider First Name:
HELEN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

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:
1336459411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88202-2775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-624-2121
Provider Business Mailing Address Fax Number:
575-624-7981

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 N UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-3267
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-624-2121
Provider Business Practice Location Address Fax Number:
575-624-7981
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0143171 , 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)

  • Identifier: 03838528 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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