Provider Demographics
NPI:1205978319
Name:EL PASO COUNSELING CENTER OF EXPRESSIVE ARTS PC
Entity type:Organization
Organization Name:EL PASO COUNSELING CENTER OF EXPRESSIVE ARTS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, LMFT, RPT-S
Authorized Official - Phone:915-845-3122
Mailing Address - Street 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE B1
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5002
Mailing Address - Country:US
Mailing Address - Phone:915-845-3122
Mailing Address - Fax:915-845-4165
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE B1
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5002
Practice Address - Country:US
Practice Address - Phone:915-845-3122
Practice Address - Fax:915-845-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158288402Medicaid