Provider Demographics
NPI:1679179840
Name:PECOS VALLEY COUNSELING
Entity Type:Organization
Organization Name:PECOS VALLEY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:575-517-0931
Mailing Address - Street 1:1894 CHAPARRAL LOOP
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-3718
Mailing Address - Country:US
Mailing Address - Phone:575-517-0931
Mailing Address - Fax:575-706-9426
Practice Address - Street 1:614 BECKER AVE
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-3634
Practice Address - Country:US
Practice Address - Phone:575-517-0931
Practice Address - Fax:575-706-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty