Provider Demographics
NPI:1518180777
Name:DAVE L. CRANE
Entity Type:Organization
Organization Name:DAVE L. CRANE
Other - Org Name:MESA COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-461-6200
Mailing Address - Street 1:102 E HIGH ST
Mailing Address - Street 2:P.O. BOX 881
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-2726
Mailing Address - Country:US
Mailing Address - Phone:575-461-6200
Mailing Address - Fax:
Practice Address - Street 1:102 E HIGH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2726
Practice Address - Country:US
Practice Address - Phone:505-461-6200
Practice Address - Fax:505-461-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM006177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM43220380Medicaid