Healthcare Provider Details

I. General information

NPI: 1104763283
Provider Name (Legal Business Name): SARA LESLIE CHAPMAN LSAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 PORR DR
RUIDOSO NM
88345-6713
US

IV. Provider business mailing address

PO BOX 505
CAPITAN NM
88316-0505
US

V. Phone/Fax

Practice location:
  • Phone: 575-937-1665
  • Fax:
Mailing address:
  • Phone: 575-937-1665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0211851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: