Provider Demographics
NPI:1851884423
Name:NUEVA VIDA COUNSELING AND CONSULTING SERVICES LLC
Entity Type:Organization
Organization Name:NUEVA VIDA COUNSELING AND CONSULTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & MENTAL HEALTH PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TOURANGEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LADAC, LCSW, PHD
Authorized Official - Phone:505-429-0905
Mailing Address - Street 1:NUEVA VIDA COUNSELING & CONSULTING SERVICES LLC
Mailing Address - Street 2:1920 7TH STREET
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701
Mailing Address - Country:US
Mailing Address - Phone:505-429-0905
Mailing Address - Fax:505-425-2913
Practice Address - Street 1:NUEVA VIDA COUNSELING & CONSULTING SERVICES LLC
Practice Address - Street 2:1920 7TH STREET
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701
Practice Address - Country:US
Practice Address - Phone:505-429-0905
Practice Address - Fax:505-425-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-4248251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM49084364Medicaid