Provider Demographics
NPI:1871509554
Name:PASTORAL COUNSELING CENTER
Entity type:Organization
Organization Name:PASTORAL COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:DENNEDY-FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-988-4131
Mailing Address - Street 1:1533 S SAINT FRANCIS DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4032
Mailing Address - Country:US
Mailing Address - Phone:505-988-4131
Mailing Address - Fax:505-992-6145
Practice Address - Street 1:1533 S SAINT FRANCIS DR
Practice Address - Street 2:SUITE E
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4032
Practice Address - Country:US
Practice Address - Phone:505-988-4131
Practice Address - Fax:505-992-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM39994261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMA 1096Medicaid