Healthcare Provider Details

I. General information

NPI: 1881842284
Provider Name (Legal Business Name): SANDY FLORES MA, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 01/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7228 MILAN HILLS RD NE
RIO RANCHO NM
87144-0838
US

IV. Provider business mailing address

7228 MILAN HILLS RD NE
RIO RANCHO NM
87144-0838
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-9428
  • Fax: 505-771-9428
Mailing address:
  • Phone: 505-771-9428
  • Fax: 505-771-9428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0128571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: