Healthcare Provider Details

I. General information

NPI: 1902750896
Provider Name (Legal Business Name): EVORA THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400A N WASHINGTON AVE
ROSWELL NM
88201-8267
US

IV. Provider business mailing address

PO BOX 832
ROSWELL NM
88202-0832
US

V. Phone/Fax

Practice location:
  • Phone: 575-910-1440
  • Fax:
Mailing address:
  • Phone: 575-910-1440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ELVA BURILLO
Title or Position: OWNER
Credential: LCSW
Phone: 575-420-9430