Healthcare Provider Details

I. General information

NPI: 1265674154
Provider Name (Legal Business Name): SALLY BELLE VON ERFFA LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7013 4TH ST NW STE C
LOS RANCHOS NM
87107-6639
US

IV. Provider business mailing address

376 LOS RANCHOS RD NW
LOS RANCHOS NM
87107-6532
US

V. Phone/Fax

Practice location:
  • Phone: 505-356-2200
  • Fax: 844-272-7030
Mailing address:
  • Phone: 505-252-6797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60533946
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC# 47140
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF0200791
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: