Organization
OASIS THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEIDRA CORDOVA LCSW (OWNER)
(505) 617-1180
Entity
Organization
Contact information
Practice address
2534 RIDGE RUNNER RD, LAS VEGAS, NM 87701-4971
(505) 617-1180
Mailing address
PO BOX 45681, RIO RANCHO, NM 87174-5681
(505) 226-1960
(505) 672-7769
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
05/12/2021
Last updated
05/12/2021
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