Healthcare Provider Details

I. General information

NPI: 1346961083
Provider Name (Legal Business Name): FAITH ELIZABETH ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 09/12/2022
Certification Date: 09/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N JEFFERSON ST
HOBBS NM
88240-5332
US

IV. Provider business mailing address

809 W AVENUE C
LOVINGTON NM
88260-4344
US

V. Phone/Fax

Practice location:
  • Phone: 575-390-6968
  • Fax:
Mailing address:
  • Phone: 575-390-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: