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Ruidoso, New Mexico

Provider NPI: 1578637492

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
Tel: 575-937-1214  Fax: 575-258-9445

Business Mailing Address:
1096 MECHEM DR STE 309  RUIDOSO, NM 88345 US
Tel: 575-937-1214  Fax: --

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Addiction (Substance Use Disorder)
Y101YM0800XBehavioral Health & Social Service Providers
N101YP2500XBehavioral Health & Social Service Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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