Basic Information
| Provider Information | |||||||||
| NPI: | 1346402070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMANECER PSYCHOLOGICAL SERVICES, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1219 BARRANCA DR | ||||||||
| Address2: | STE A AND B | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157795600 | ||||||||
| FaxNumber: | 9157795605 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 BARRANCA DR | ||||||||
| Address2: | STE A AND B | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157795600 | ||||||||
| FaxNumber: | 9157795605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2008 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | BASURTO | ||||||||
| AuthorizedOfficialFirstName: | RODOLFO | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9157795600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | 3550-3555 | TX | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 261QR0405X | 3550-3555 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.