Provider Demographics
NPI:1750508529
Name:FUTURA VISTA INC.
Entity Type:Organization
Organization Name:FUTURA VISTA INC.
Other - Org Name:FUTURA VISTA GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-607-7774
Mailing Address - Street 1:1205 JONES ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-5540
Mailing Address - Country:US
Mailing Address - Phone:505-763-5887
Mailing Address - Fax:505-762-9159
Practice Address - Street 1:1205 JONES ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-5540
Practice Address - Country:US
Practice Address - Phone:505-763-5887
Practice Address - Fax:505-762-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600911OtherVALUE OPTIONS PROVIDER ID
NM130187Medicaid