Healthcare Provider Details

I. General information

NPI: 1588397871
Provider Name (Legal Business Name): KATHERINE IRENE CONVERY LSAA, LMSW-P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N POPE ST
SILVER CITY NM
88061-5161
US

IV. Provider business mailing address

530 DEMOSS ST.
LORDSBURG NM
88045
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-1467
  • Fax: 575-313-8236
Mailing address:
  • Phone: 575-800-1467
  • Fax: 575-313-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCTB-2022-0252
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0066
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: