Provider Demographics
NPI:1740716471
Name:COREY VAS COUNSELING INC
Entity type:Organization
Organization Name:COREY VAS COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-496-2616
Mailing Address - Street 1:741 N ALAMEDA BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2172
Mailing Address - Country:US
Mailing Address - Phone:575-496-2616
Mailing Address - Fax:575-571-4483
Practice Address - Street 1:741 N ALAMEDA BLVD STE 6
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2172
Practice Address - Country:US
Practice Address - Phone:575-496-2616
Practice Address - Fax:575-571-4483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0844251S00000X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health