Healthcare Provider Details

I. General information

NPI: 1801994728
Provider Name (Legal Business Name): NEW MEXICO PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W APACHE ST
FARMINGTON NM
87401-5511
US

IV. Provider business mailing address

701 W APACHE ST
FARMINGTON NM
87401-5511
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-7777
  • Fax: 505-327-7779
Mailing address:
  • Phone: 505-327-7777
  • Fax: 505-327-7779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number142
License Number StateNM

VIII. Authorized Official

Name: DR. ROBERT EDWARD SHERRILL, JR.
Title or Position: PRESIDENT
Credential: PHD
Phone: 505-327-7777