Provider Demographics
NPI:1619152238
Name:RIO PECOS COUNSELING AND HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:RIO PECOS COUNSELING AND HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-234-1644
Mailing Address - Street 1:608 N CANYON ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5816
Mailing Address - Country:US
Mailing Address - Phone:575-234-1644
Mailing Address - Fax:575-887-2685
Practice Address - Street 1:608 N CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5816
Practice Address - Country:US
Practice Address - Phone:575-234-1644
Practice Address - Fax:575-887-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0076041101YM0800X
R57579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty