Healthcare Provider Details

I. General information

NPI: 1053839944
Provider Name (Legal Business Name): CLINICAL COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 VERMONT AVE
ALAMOGORDO NM
88310-6340
US

IV. Provider business mailing address

1617 ROSALIA LN
ALAMOGORDO NM
88310-6313
US

V. Phone/Fax

Practice location:
  • Phone: 575-415-9270
  • Fax: 208-978-7050
Mailing address:
  • Phone: 575-415-9270
  • Fax: 208-978-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0093781
License Number StateNM

VIII. Authorized Official

Name: MARY ELIZABETH SAWYERS
Title or Position: CLINICAL COUNSELOR
Credential: MA, LPCC
Phone: 575-415-9270