Healthcare Provider Details

I. General information

NPI: 1174924344
Provider Name (Legal Business Name): SHERRICA CRESSOR LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POND ROAD COUNTY ROAD 11
CUBA NM
87114
US

IV. Provider business mailing address

PO BOX 580
CUBA NM
87013-0580
US

V. Phone/Fax

Practice location:
  • Phone: 505-346-0075
  • Fax:
Mailing address:
  • Phone: 305-469-8277
  • Fax: 575-289-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11815
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0197691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: