MEDICARE: KERRY NIEC MA LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1427617612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERRY NIEC MA LPCC

Provider Business Mailing Address
First Line	:	PO BOX 3772
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-6772
Country	:	US
Telephone Number	:	505-426-7847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 HOT SPRINGS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-4093
Country	:	US
Telephone Number	:	505-426-7847
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL MENTAL HEALTH COUNSELOR
Name	:	KERRY NIEC
Credential	:	LPCC
Telephone Number	:	505-426-7847

Provider Enumeration Date	:	06/11/2019
Last Update Date	:	08/27/2021

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