Provider Demographics
NPI:1053505115
Name:COUNSELING AND MEDIATION SERVICES
Entity Type:Organization
Organization Name:COUNSELING AND MEDIATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARCILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLGUIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-882-5290
Mailing Address - Street 1:PO BOX 1063
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-1063
Mailing Address - Country:US
Mailing Address - Phone:575-805-5089
Mailing Address - Fax:575-882-1879
Practice Address - Street 1:880 ANTHONY DR
Practice Address - Street 2:SUITE 3B
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9346
Practice Address - Country:US
Practice Address - Phone:575-805-5089
Practice Address - Fax:575-882-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM16070216Medicaid