MEDICARE: SALLY HUNTER LCSW

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	1041C0700X	Clinical Social Worker	M-08442	NM
2	1041C0700X	Clinical Social Worker	C-09374	NM

General Provider Information

NPI Number	:	1932527140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY HUNTER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 156
Second Line	:
City	:	JEMEZ SPRINGS
State	:	NM
Zip	:	87025-0156
Country	:	US
Telephone Number	:	505-250-3460
Fax Number	:

Provider Business Practice Location Address
First Line	:	17570 NM 4
Second Line	:
City	:	JEMEZ SPRINGS
State	:	NM
Zip	:	87025
Country	:	US
Telephone Number	:	505-250-3460
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2014
Last Update Date	:	08/26/2022

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Directions to “ SALLY HUNTER LCSW” Practice Location

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