Arbol de la Vida Psychological Services, LLC
Organization Active NPI Community/Behavioral Health Agency · Mesilla, NM
NPI 1932771805 · NPPES record last updated Jul 12, 2021
Key facts
- NPI
- 1932771805
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- ARBOL DE LA VIDA PSYCHOLOGICAL SERVICES, LLC
- Practice address
- 2488 Calle de Guadalupe
Mesilla, NM 88046-0594 - Phone
- (915) 494-0671
- NPI assigned
- Jul 12, 2021
- Organization subpart
- No
Authorized official
- Name
- Dr. Virginia Longoria, PH.D.
- Title
- Owner
- Phone
- (915) 494-0671
Practitioners 2
-
Violeta Blanca Jaure, PHD, LPCC, LADAC
-
Virginia Longoria, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211004001637 | NM | Part B Supplier - Clinic/Group Practice | 4880092972 |
Receives reassigned benefits from 2 practitioners Practice locations: Mesilla, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
2488 Calle de Guadalupe
Mesilla, NM 88046-0594
Mailing address
703 N Reymond St
Las Cruces, NM 88005-2135
Phone (915) 494-0671
Other providers in Mesilla, NM
All providers in Mesilla, NM · Community/Behavioral Health Agency in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.