Provider Demographics
NPI:1710676127
Name:A SPECIAL PLACE COUNSELING NEW MEXICO LLC
Entity Type:Organization
Organization Name:A SPECIAL PLACE COUNSELING NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:CALE ARREOLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:505-652-2353
Mailing Address - Street 1:24 STARGAZER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-9624
Mailing Address - Country:US
Mailing Address - Phone:505-376-9000
Mailing Address - Fax:
Practice Address - Street 1:24 STARGAZER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-9624
Practice Address - Country:US
Practice Address - Phone:505-652-2353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)