Provider Demographics
NPI:1710323829
Name:SHAVANO COUNSELING SERVICES
Entity Type:Organization
Organization Name:SHAVANO COUNSELING SERVICES
Other - Org Name:JOSHUA NEWMAN, LPCC COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:479-530-5772
Mailing Address - Street 1:1330 LOMAS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1234
Mailing Address - Country:US
Mailing Address - Phone:479-530-5772
Mailing Address - Fax:866-751-2593
Practice Address - Street 1:1330 LOMAS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-1234
Practice Address - Country:US
Practice Address - Phone:479-530-5772
Practice Address - Fax:866-751-2593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0157231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty