Provider Demographics
NPI:1730411299
Name:DESERT VISTA COUNSELING AND BEHAVIORAL HEALTH SERVICE, LLC
Entity type:Organization
Organization Name:DESERT VISTA COUNSELING AND BEHAVIORAL HEALTH SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:CMHC
Authorized Official - Phone:915-355-0497
Mailing Address - Street 1:229 ANGELINA
Mailing Address - Street 2:
Mailing Address - City:CHAPARRAL
Mailing Address - State:NM
Mailing Address - Zip Code:88081-7558
Mailing Address - Country:US
Mailing Address - Phone:915-355-0497
Mailing Address - Fax:
Practice Address - Street 1:229 ANGELINA
Practice Address - Street 2:
Practice Address - City:CHAPARRAL
Practice Address - State:NM
Practice Address - Zip Code:88081-7558
Practice Address - Country:US
Practice Address - Phone:915-355-0497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4226056251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health