| Childrens Grief Center Of El Paso | |
|
11625 Pellicano Dr Ste B El Paso TX 79936-6242 | |
| (915) 532-6004 | |
| Not Available |
| Full Name | Childrens Grief Center Of El Paso |
|---|---|
| Speciality | Counselor |
| Location | 11625 Pellicano Dr Ste B, El Paso, Texas |
| Authorized Official Name and Position | Kathryn Leigh Revtyak (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9153381476 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Childrens Grief Center Of El Paso 11625 Pellicano Dr Ste B El Paso TX 79936-6242 Ph: (915) 532-6004 | Childrens Grief Center Of El Paso 11625 Pellicano Dr Ste B El Paso TX 79936-6242 Ph: (915) 532-6004 |
| NPI Number | 1154127470 |
|---|---|
| Provider Enumeration Date | 02/19/2025 |
| Last Update Date | 02/28/2025 |
| Certification Date | 02/28/2025 |
| Medicare PECOS PAC ID | 7810418282 |
|---|---|
| Medicare Enrollment ID | O20250303001381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154127470 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Janine Gallinar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891092805 PECOS PAC ID: 3476731605 Enrollment ID: I20110616000837 |
| Provider Name | Kathryn L Revtyak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821385071 PECOS PAC ID: 7618148669 Enrollment ID: I20110922000472 |
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