Provider Demographics
NPI:1043556897
Name:EUBANK COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:EUBANK COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROF CLINICAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:EUBANK
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:505-327-0264
Mailing Address - Street 1:2103 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-3220
Mailing Address - Country:US
Mailing Address - Phone:505-327-0264
Mailing Address - Fax:505-325-9035
Practice Address - Street 1:2103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3220
Practice Address - Country:US
Practice Address - Phone:505-327-0264
Practice Address - Fax:505-325-9035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0095601251S00000X
NM0095591251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health