Healthcare Provider Details

I. General information

NPI: 1083488712
Provider Name (Legal Business Name): LISA BERNARD-WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WESTRIDGE RD
CARLSBAD NM
88220-3550
US

IV. Provider business mailing address

PO BOX 3141
CARLSBAD NM
88221-3141
US

V. Phone/Fax

Practice location:
  • Phone: 575-725-5552
  • Fax:
Mailing address:
  • Phone: 575-725-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0124
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: