Provider Demographics
NPI:1720592538
Name:EASTERN SLOPE COUNSELING AND CONSULTING, LLC
Entity Type:Organization
Organization Name:EASTERN SLOPE COUNSELING AND CONSULTING, LLC
Other - Org Name:EASTERN SLOPE COUNSELING AND CONSULTING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER/OWNER/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PATNAUDE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-286-6112
Mailing Address - Street 1:12056 STATE HIGHWAY 14 N
Mailing Address - Street 2:
Mailing Address - City:CEDAR CREST
Mailing Address - State:NM
Mailing Address - Zip Code:87008-9405
Mailing Address - Country:US
Mailing Address - Phone:505-286-6112
Mailing Address - Fax:505-286-6112
Practice Address - Street 1:12126 STATE HIGHWAY 14 N STE E
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-9406
Practice Address - Country:US
Practice Address - Phone:505-286-6112
Practice Address - Fax:505-286-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22521542Medicaid