Basic Information
| Provider Information | |||||||||
| NPI: | 1588997373 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLANCO | ||||||||
| FirstName: | RAYNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 W COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880615002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753138222 | ||||||||
| FaxNumber: | 5753138226 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 W COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880615002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753138222 | ||||||||
| FaxNumber: | 5753138226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2009 | ||||||||
| LastUpdateDate: | 11/21/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0119311 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.