Healthcare Provider Details

I. General information

NPI: 1003089079
Provider Name (Legal Business Name): TERRY BARSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1299 B PASEO DEL PUEBLO NORTE
EL PRADO NM
87529
US

IV. Provider business mailing address

HC 74 BOX 20412
EL PRADO NM
87529-9504
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-7263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0091171
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: