Provider Demographics
NPI:1578602413
Name:ACTION COUNSELING SERVICE LLC
Entity Type:Organization
Organization Name:ACTION COUNSELING SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LMFT LPCC
Authorized Official - Phone:505-317-5101
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:3507 RIVERSIDE DR
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202
Mailing Address - Country:US
Mailing Address - Phone:505-317-5101
Mailing Address - Fax:
Practice Address - Street 1:3505 RIVERSIDE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:505-317-5101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC005511101YP2500X
NMLMFT4794106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68785721Medicaid