Healthcare Provider Details

I. General information

NPI: 1962736215
Provider Name (Legal Business Name): MARGARITA SILVA POTTS L.P.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 GRANT ST.
BAYARD NM
88023
US

IV. Provider business mailing address

PO BOX 1003
BAYARD NM
88023-1003
US

V. Phone/Fax

Practice location:
  • Phone: 575-590-2202
  • Fax:
Mailing address:
  • Phone: 575-590-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0101621
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401002991
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: