Basic Information
| Provider Information | |||||||||
| NPI: | 1841538055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ORNELAS | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CALDWELL | ||||||||
| OtherFirstName: | SUZANNE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPCC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2012 W MANN AVE | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882102257 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753657335 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1105 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757469848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2013 | ||||||||
| LastUpdateDate: | 01/22/2013 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 0083921 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.