Facts
- Status
- A
- Credential
- LPCC
- Type
- Individual
- Enumeration date
- 2011-05-24
- Last updated
- 2012-11-28
Specialties
Licenses
- License NM
- 0138451
Location
- Practice location
- 204 AUTUMN SAGE LN
- City
- CHAPARRAL NM
- Postal code
- 880817732
- Phone
- 575-824-4388
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.