Provider Demographics
NPI:1164755807
Name:EL PASO CHILD GUIDANCE CENTER
Entity Type:Organization
Organization Name:EL PASO CHILD GUIDANCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST I
Authorized Official - Prefix:MS
Authorized Official - First Name:PHILLIS
Authorized Official - Middle Name:BEATRICE
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:915-562-1999
Mailing Address - Street 1:2701 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3726
Mailing Address - Country:US
Mailing Address - Phone:915-562-1999
Mailing Address - Fax:
Practice Address - Street 1:2701 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3726
Practice Address - Country:US
Practice Address - Phone:915-562-1999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX407391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty