Provider Demographics
NPI:1396391447
Name:CONTRERAS COUNSELING, LLC
Entity Type:Organization
Organization Name:CONTRERAS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LPCC
Authorized Official - Phone:505-450-4094
Mailing Address - Street 1:792 DIANE AVE.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-4910
Mailing Address - Country:US
Mailing Address - Phone:505-398-0117
Mailing Address - Fax:505-425-0701
Practice Address - Street 1:1618 7TH STREET
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4920
Practice Address - Country:US
Practice Address - Phone:505-398-0117
Practice Address - Fax:505-425-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty