Healthcare Provider Details

I. General information

NPI: 1407797293
Provider Name (Legal Business Name): SUA SPONTE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 CARLYLE PL
LAS CRUCES NM
88005-1474
US

IV. Provider business mailing address

2240 CARLYLE PL
LAS CRUCES NM
88005-1474
US

V. Phone/Fax

Practice location:
  • Phone: 575-442-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTIN MEDINA
Title or Position: OWNER
Credential: LCSW
Phone: 575-442-2211