Healthcare Provider Details

I. General information

NPI: 1437351962
Provider Name (Legal Business Name): PRISCILLA ANN SCHLABACH LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRISCILLA ANN KELLEY LCSW

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S HUDSON ST BORDER AREA MENTAL HEALTH SERVICES, INC.
SILVER CITY NM
88061-6184
US

IV. Provider business mailing address

PO BOX 1349 BORDER AREA MENTAL HEALTH SERVICE
SILVER CITY NM
88062-1349
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4412
  • Fax: 575-534-1150
Mailing address:
  • Phone: 575-388-4497
  • Fax: 575-534-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3128
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1-07704
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: