Healthcare Provider Details

I. General information

NPI: 1316291792
Provider Name (Legal Business Name): SPECIAL NEEDS CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N MAIN ST
ROSWELL NM
88201-4722
US

IV. Provider business mailing address

PO BOX 5834
ROSWELL NM
88202-5834
US

V. Phone/Fax

Practice location:
  • Phone: 575-420-9380
  • Fax:
Mailing address:
  • Phone: 575-624-2095
  • Fax: 575-627-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP-02032
License Number StateNM

VIII. Authorized Official

Name: TRACEY LUNA
Title or Position: OWNER
Credential: CNP
Phone: 575-420-9380