Healthcare Provider Details

I. General information

NPI: 1659063600
Provider Name (Legal Business Name): SMART PERSPECTIVES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 CUBA AVE STE 1
ALAMOGORDO NM
88310-5646
US

IV. Provider business mailing address

3122 SUMMER AVE
ALAMOGORDO NM
88310-4062
US

V. Phone/Fax

Practice location:
  • Phone: 575-404-1593
  • Fax: 575-404-1593
Mailing address:
  • Phone: 575-404-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS AARON RUSSELL
Title or Position: CCO (CHIEF COUNSELING OFFICER)
Credential: LPCC
Phone: 575-495-4526