Healthcare Provider Details

I. General information

NPI: 1508321555
Provider Name (Legal Business Name): ASHLEE MCEWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 WARRIOR DR
RUIDOSO NM
88345-6026
US

IV. Provider business mailing address

158 WILLIE HORTON DR
RUIDOSO NM
88345-7708
US

V. Phone/Fax

Practice location:
  • Phone: 575-630-7974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0201631
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: