Provider Demographics
NPI:1588007389
Name:SANDRA B. EMANUEL, LLC
Entity Type:Organization
Organization Name:SANDRA B. EMANUEL, LLC
Other - Org Name:GENESIS COUNESLING OF LAS CRUCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-644-3860
Mailing Address - Street 1:218 N.CAMPO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3172
Mailing Address - Country:US
Mailing Address - Phone:575-647-8131
Mailing Address - Fax:575-541-7449
Practice Address - Street 1:218 N CAMPO ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3508
Practice Address - Country:US
Practice Address - Phone:575-647-8131
Practice Address - Fax:575-541-7449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-08154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty