Provider Demographics
NPI:1124594973
Name:CREATING CONNECTIONS COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:CREATING CONNECTIONS COUNSELING SERVICES LLC
Other - Org Name:CREATING CONNECTION COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAFRENIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-635-0407
Mailing Address - Street 1:255 W HADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1806
Mailing Address - Country:US
Mailing Address - Phone:575-915-4866
Mailing Address - Fax:575-993-5361
Practice Address - Street 1:255 W HADLEY AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1806
Practice Address - Country:US
Practice Address - Phone:575-915-4866
Practice Address - Fax:575-993-5361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-19
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)