Healthcare Provider Details

I. General information

NPI: 1164970877
Provider Name (Legal Business Name): KATHERINE N. HALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE N. LEDBETTER LMSW

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 12/18/2019
Certification Date: 12/18/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SUTTER PL
CLOVIS NM
88101-4611
US

IV. Provider business mailing address

1129 AQUARIUS DR
PORTALES NM
88130-6109
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-4490
  • Fax:
Mailing address:
  • Phone: 575-791-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-10551
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: