Adult and Adolescent Counseling, PLLC

Organization Active NPI Clinical Psychologist · El Paso, TX

NPI 1063568624 · NPPES record last updated Feb 27, 2024

Key facts

NPI
1063568624
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Psychologist 103TC0700X
License
34562 (TX)
Legal business name
ADULT AND ADOLESCENT COUNSELING, PLLC
Practice address
2332 Montana Ave
El Paso, TX 79903-3604
Phone
(915) 545-1188
Fax
(915) 544-9107
NPI assigned
Jan 26, 2007
Organization subpart
No

Authorized official

Name
Betsy Nacim, PHD
Title
Director
Phone
(915) 545-1188

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040624001213 TX Part B Supplier - Clinic/Group Practice 5799761482 Receives reassigned benefits from 2 practitioners
Practice locations: El Paso, TX

National Provider Directory

Locations

2332 Montana Ave
El Paso, TX 79903
Phone (914) 545-1188

2330 Montana Ave
El Paso, TX 79903
Phone (915) 545-1188

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist
Group: 193200000X MULTI-SPECIALTY GROUP
103TC0700X 34562 TX Yes
Clinical Social Worker
Group: 193200000X MULTI-SPECIALTY GROUP
1041C0700X 30164 TX

Addresses

Primary practice location

2332 Montana Ave
El Paso, TX 79903-3604

Mailing address

2332 Montana Ave
El Paso, TX 79903-3604
Phone (915) 545-1188

Other identifiers

IdentifierTypeStateIssuer
0002KXOtherTXGROUP BCBS NUMBER
149971701MedicaidTX

Other providers in El Paso, TX

All providers in El Paso, TX · Clinical Psychologist in Texas

Sources for this page

Verify at the official NPI Registry.