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Organization
AMANECER PSYCHOLOGICAL SERVICES
Active
Organization
AMANECER PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RODOLFO BASURTO PHD (PRESIDENT)
(915) 779-5600
Entity
Organization
Contact information
Practice address
6044 GATEWAY EAST, SUITE 405, EL PASO, TX 79905
(915) 779-5600
(915) 779-5605
Mailing address
6044 GATEWAY EAST, SUITE 405, EL PASO, TX 79905
(915) 779-5600
(915) 779-5605
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046HQ
BCBS OF TEXAS
TX
01
—
NM600035
NM MEDICAID
NM
Enumeration date
10/03/2006
Last updated
08/22/2020
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