Healthcare Provider Details

I. General information

NPI: 1912248204
Provider Name (Legal Business Name): ERIN ELIZABETH BUSBY MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN ELIZABETH WILSON

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W HEMLOCK ST
DEMING NM
88030-3622
US

IV. Provider business mailing address

118 S IRON ST
DEMING NM
88030-3628
US

V. Phone/Fax

Practice location:
  • Phone: 575-694-5478
  • Fax:
Mailing address:
  • Phone: 575-694-5478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0217041
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: