Christopher David Aguilar

Individual provider Active NPI Professional Counselor · Ribera, NM

NPI 1164109088 · NPPES record last updated Jul 3, 2023

Key facts

NPI
1164109088
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
CCMH0199471 (NM)
Practice address
12 Sagebrush Way
Ribera, NM 87560-8014
Phone
(754) 210-5105
NPI assigned
Jul 3, 2023
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CCMH0199471NMMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Vida Entera Therapeutic Services Professional Current
since Jul 9, 2023
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP
101YP2500X CCMH0199471 NM Yes

Addresses

Primary practice location

12 Sagebrush Way
Ribera, NM 87560-8014

Mailing address

PO Box 397
Ribera, NM 87560-0397
Phone (754) 210-5105

Other providers in Ribera, NM

All providers in Ribera, NM · Professional Counselor in New Mexico

Sources for this page

Verify at the official NPI Registry.