Provider Demographics
NPI:1346402070
Name:AMANECER PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:AMANECER PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:BASURTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:915-779-5600
Mailing Address - Street 1:1219 BARRANCA DR
Mailing Address - Street 2:STE A AND B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4601
Mailing Address - Country:US
Mailing Address - Phone:915-779-5600
Mailing Address - Fax:915-779-5605
Practice Address - Street 1:1219 BARRANCA DR
Practice Address - Street 2:STE A AND B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4601
Practice Address - Country:US
Practice Address - Phone:915-779-5600
Practice Address - Fax:915-779-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3550-3555261QR0405X, 276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit