| Pupfish Llc | |
|
279 Shadow Mountain Dr # 307 El Paso TX 79912-4707 | |
| (713) 504-2681 | |
| Not Available |
| Full Name | Pupfish Llc |
|---|---|
| Speciality | Counselor |
| Location | 279 Shadow Mountain Dr # 307, El Paso, Texas |
| Authorized Official Name and Position | Joseph Carlson (OWNER/LPC) |
| Authorized Official Contact | 7135042681 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pupfish Llc 6848 Orizaba Ave El Paso TX 79912-2306 Ph: (713) 504-2681 | Pupfish Llc 279 Shadow Mountain Dr # 307 El Paso TX 79912-4707 Ph: (713) 504-2681 |
| NPI Number | 1023587334 |
|---|---|
| Provider Enumeration Date | 11/15/2018 |
| Last Update Date | 11/16/2018 |
| Medicare PECOS PAC ID | 2567994155 |
|---|---|
| Medicare Enrollment ID | O20241021003760 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023587334 | NPI | - | NPPES |
| PENDING | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Joseph Andrew Carlson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1508382599 PECOS PAC ID: 4385176973 Enrollment ID: I20241114002244 |
| Provider Name | Mallela Ramirez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1912749755 PECOS PAC ID: 0143755579 Enrollment ID: I20241122000095 |
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