Provider Demographics
NPI:1235732660
Name:MIMBRES COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:MIMBRES COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFSTATHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YERENDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-621-0592
Mailing Address - Street 1:23 CALLE BLANCA
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-7825
Mailing Address - Country:US
Mailing Address - Phone:575-621-0592
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE BLANCA
Practice Address - Street 2:
Practice Address - City:CORRALES
Practice Address - State:NM
Practice Address - Zip Code:87048-7825
Practice Address - Country:US
Practice Address - Phone:575-621-0592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty