Healthcare Provider Details

I. General information

NPI: 1407454747
Provider Name (Legal Business Name): CHERIE SPURLIN LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 GALLAHAD ST SW
LOS LUNAS NM
87031-9152
US

IV. Provider business mailing address

808 GALLAHAD ST SW
LOS LUNAS NM
87031-9152
US

V. Phone/Fax

Practice location:
  • Phone: 505-907-3413
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0213661
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2022-0857
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: