1497947519 NPI number — ALAMOGORDO COUNSELING ASSOCIATES, LLC

Table of Contents

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)





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