Healthcare Provider Details

I. General information

NPI: 1104375344
Provider Name (Legal Business Name): KRISTY L. SCULLION-MCPHERSON, PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 EL MOLINO BLVD
LAS CRUCES NM
88005-2915
US

IV. Provider business mailing address

350 EL MOLINO BLVD
LAS CRUCES NM
88005-2915
US

V. Phone/Fax

Practice location:
  • Phone: 575-642-7200
  • Fax: 575-524-5968
Mailing address:
  • Phone: 575-642-7200
  • Fax: 575-524-5968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1013
License Number StateNM

VIII. Authorized Official

Name: KRISTY L. SCULLION-MCPHERSON
Title or Position: OWNER
Credential: PHD
Phone: 575-642-7200