Active NPI
Peter Paul Pecos, LADC
- Addiction (Substance Use Disorder) Counselor
- Jemez Pueblo, NM
National Provider Identifier
1669662979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 0105861
- Practice address
- 110 Sheep Springs Way
Jemez Pueblo, NM 87024 - Phone
- (505) 834-7258
- Fax
- (505) 834-9501
- NPI assigned
- Aug 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0105861 | NM | Primary |
Addresses
Primary practice location
110 Sheep Springs Way
Jemez Pueblo, NM 87024
Mailing address
110 Sheep Springs Way
Jemez Pueblo, NM 87024
Phone (505) 834-7258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0105861 | NM | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1669662979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 SHEEP SPRINGS WAY",
"city": "JEMEZ PUEBLO",
"state": "NM",
"postal_code": "87024",
"telephone_number": "505-834-7258",
"fax_number": "505-834-9501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 SHEEP SPRINGS WAY",
"city": "JEMEZ PUEBLO",
"state": "NM",
"postal_code": "87024",
"telephone_number": "505-834-7258",
"fax_number": "505-834-9501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PECOS",
"first_name": "PETER",
"middle_name": "PAUL",
"credential": "LADC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-01",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "NM",
"license": "0105861",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jemez Pueblo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.