Provider Demographics
NPI:1699012245
Name:NORTHERN NEW MEXICO COUNSELING SERVICES, L.L.C.
Entity Type:Organization
Organization Name:NORTHERN NEW MEXICO COUNSELING SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THORP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-660-5726
Mailing Address - Street 1:555 OPPENHEIMER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2384
Mailing Address - Country:US
Mailing Address - Phone:505-660-5726
Mailing Address - Fax:
Practice Address - Street 1:555 OPPENHEIMER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2384
Practice Address - Country:US
Practice Address - Phone:505-660-5726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-048851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty