Provider Demographics
NPI:1356435903
Name:AMANECER PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:AMANECER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:BASURTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:915-779-5600
Mailing Address - Street 1:6044 GATEWAY EAST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-779-5600
Mailing Address - Fax:915-779-5605
Practice Address - Street 1:6044 GATEWAY EAST
Practice Address - Street 2:SUITE 405
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905
Practice Address - Country:US
Practice Address - Phone:915-779-5600
Practice Address - Fax:915-779-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046HQOtherBCBS OF TEXAS
NMNM600035OtherNM MEDICAID
TX=========OtherTRICARE