Provider Demographics
NPI:1477897759
Name:RISING SUN HOLISTIC COUNSELING
Entity Type:Organization
Organization Name:RISING SUN HOLISTIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEFA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:575-571-9980
Mailing Address - Street 1:742 STAGECOACH DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8034
Mailing Address - Country:US
Mailing Address - Phone:575-571-9980
Mailing Address - Fax:575-522-8907
Practice Address - Street 1:742 STAGECOACH DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8034
Practice Address - Country:US
Practice Address - Phone:575-571-9980
Practice Address - Fax:575-522-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-3048251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000J0585Medicaid