Provider Demographics
NPI:1942510748
Name:FRESQUEZ, WILLIAM (LADAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:FRESQUEZ
Suffix:
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HWY 121 #595
Mailing Address - Street 2:P.O. BOX 72
Mailing Address - City:CHACON
Mailing Address - State:NM
Mailing Address - Zip Code:87713-0072
Mailing Address - Country:US
Mailing Address - Phone:575-387-2764
Mailing Address - Fax:
Practice Address - Street 1:508 STATE HWY 518
Practice Address - Street 2:HELPING HANDS INC
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-0708
Practice Address - Country:US
Practice Address - Phone:575-387-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3718101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor