1528382488 NPI number — COUNSELING WITHIN 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 1528382488 NPI number — COUNSELING WITHIN LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING WITHIN 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:
1528382488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1925 ASPEN DR
Provider Second Line Business Mailing Address:
STE101B
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87505-5459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-471-0402
Provider Business Mailing Address Fax Number:
505-431-6850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1925 ASPEN DR
Provider Second Line Business Practice Location Address:
STE101B
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87505-5459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-471-0402
Provider Business Practice Location Address Fax Number:
505-431-6850
Provider Enumeration Date:
03/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MEIZLISH
Authorized Official First Name:
ELAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
505-471-0402

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44187378 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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