Healthcare Provider Details

I. General information

NPI: 1366656274
Provider Name (Legal Business Name): BARBARA L. WHITLOCK M.E.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N. VIRGINIA
ROSWELL NM
88201-5126
US

IV. Provider business mailing address

1010 N. VIRGINIA
ROSWELL NM
88201-5126
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-9322
  • Fax: 575-627-6339
Mailing address:
  • Phone: 575-623-9322
  • Fax: 575-627-6339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1760
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0128911
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: