Provider Demographics
NPI:1356733158
Name:SOUTHWEST PUEBLO CONSULTANTS AND COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:SOUTHWEST PUEBLO CONSULTANTS AND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:ROBYN
Authorized Official - Last Name:ATENCIO
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-554-8302
Mailing Address - Street 1:5020 SAN PEDRO CT NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2515
Mailing Address - Country:US
Mailing Address - Phone:505-554-8302
Mailing Address - Fax:505-881-2646
Practice Address - Street 1:5020 SAN PEDRO CT NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2515
Practice Address - Country:US
Practice Address - Phone:505-554-8302
Practice Address - Fax:505-881-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFAO117647261QM0855X
NMFA0117647261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health