Healthcare Provider Details

I. General information

NPI: 1043838857
Provider Name (Legal Business Name): MICHELLE A GRAYLESS WARNACK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N GRANT ST STE A
SILVER CITY NM
88061-5134
US

IV. Provider business mailing address

1311 N GRANT ST STE A
SILVER CITY NM
88061-5134
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-1447
  • Fax: 575-388-1447
Mailing address:
  • Phone: 575-388-1447
  • Fax: 575-388-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-1292
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2025-0456
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: