Healthcare Provider Details

I. General information

NPI: 1659482396
Provider Name (Legal Business Name): NANCY LEE STEPHENS LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S HUDSON ST SUITE #6
SILVER CITY NM
88061
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4412
  • Fax: 575-534-1170
Mailing address:
  • Phone: 575-647-2800
  • Fax: 575-647-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1904
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06738
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: