Provider Demographics
NPI:1205079670
Name:WESTERN NEW MEXICO UNIVERSITY FAMILY COUNSELING CENTER
Entity type:Organization
Organization Name:WESTERN NEW MEXICO UNIVERSITY FAMILY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:YURIKO
Authorized Official - Last Name:TOYOTA-SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC,RPT-S
Authorized Official - Phone:575-538-6805
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062
Mailing Address - Country:US
Mailing Address - Phone:575-538-6805
Mailing Address - Fax:
Practice Address - Street 1:12TH AND VIRGINIA
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-538-6805
Practice Address - Fax:575-538-6482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM005895251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health