| Organization Name: | BIENESTAR FAMILY COUNSELING CENTER, LLC |
| NPI Number: | 1093080269 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIRIAM RIVAS (PRESIDENT) |
| Mailing Address: | 4950 Mcnutt Rd Santa Teresa |
| State: | NM US |
| Postal Code: | 880089621 |
| Phone Number: | 9152035103 |
| Fax Number: | 5755413669 |
| NPI Enumeration Date: | 03/20/2012 |
| NPI Last Update Date: | 03/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 0128131 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |