Provider Demographics
NPI:1659551893
Name:CENTERPOINT CHILD & FAMILY SERVICES PC
Entity Type:Organization
Organization Name:CENTERPOINT CHILD & FAMILY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARROL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPCC
Authorized Official - Phone:505-268-3064
Mailing Address - Street 1:3508 ELDER MEADOWS DR NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-0562
Mailing Address - Country:US
Mailing Address - Phone:505-268-3064
Mailing Address - Fax:505-268-9390
Practice Address - Street 1:1400 BARBARA LOOP SE
Practice Address - Street 2:SUITE D
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1088
Practice Address - Country:US
Practice Address - Phone:505-268-3064
Practice Address - Fax:505-268-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ2723Medicaid
NMNM01JA05OtherBLUE CROSS
NM10004123OtherLOVELACE HEALTH PLAN
NM4094OtherSTATE LICENSE NUMBER