Provider Demographics
NPI:1891161949
Name:OVERCOMERS COUNSELING, LLC
Entity Type:Organization
Organization Name:OVERCOMERS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:VELARDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-327-0293
Mailing Address - Street 1:475 EAST 20TH STREET
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-327-0293
Mailing Address - Fax:505-564-4925
Practice Address - Street 1:475 EAST 20TH STREET
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-327-0293
Practice Address - Fax:505-564-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM15-00002011251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health