Healthcare Provider Details

I. General information

NPI: 1013348804
Provider Name (Legal Business Name): ANN ANDERSON COUNSELING & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2013
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 N MAIN ST SUITE 304
ROSWELL NM
88201-5012
US

IV. Provider business mailing address

411 E COLLEGE BLVD
ROSWELL NM
88201-7524
US

V. Phone/Fax

Practice location:
  • Phone: 575-626-9727
  • Fax:
Mailing address:
  • Phone: 575-626-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberI-3021
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3566
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2179
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2179
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-3021
License Number StateNM

VIII. Authorized Official

Name: MS. ANN STEGE ANDERSON
Title or Position: COUNSELOR& CONSULTANT
Credential: LISW, LADAC, LPCC
Phone: 575-626-9727