Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 0159481 | NM |
N | 101YM0800X | Mental Health Counselor | 0159481 | NM |
N | 101YP2500X | Professional Counselor | 0159481 | NM |
N | 101YS0200X | School Counselor | 226742 | NM |
N | 103K00000X | Behavior Analyst | 226742 | NM |
NPI | 1215358767 |
---|---|
Provider Name | Mr. Jim Croto, Ma, Lpcc |
First Address | Las Vegas, NM 87701-0925 |
Second Address | Las Vegas, NM 87701-3734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2014 |
Last Update Date | 01/01/2014 |