Provider Demographics
NPI:1124632625
Name:LIBERA BEHAVIORAL HEALTH CENTER
Entity type:Organization
Organization Name:LIBERA BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-688-5060
Mailing Address - Street 1:3249 MANNY AGUILERA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2760
Mailing Address - Country:US
Mailing Address - Phone:832-998-7387
Mailing Address - Fax:832-200-3005
Practice Address - Street 1:3249 MANNY AGUILERA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2760
Practice Address - Country:US
Practice Address - Phone:832-998-7387
Practice Address - Fax:832-200-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty