Healthcare Provider Details

I. General information

NPI: 1093094591
Provider Name (Legal Business Name): ASHLEIGH PRATT LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2011
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 FIR ST
T OR C NM
87901-1724
US

IV. Provider business mailing address

808 FIR ST
TRUTH OR CONSEQUENCES NM
87901-1724
US

V. Phone/Fax

Practice location:
  • Phone: 505-433-1427
  • Fax:
Mailing address:
  • Phone: 508-560-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW127004
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number402514
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0764
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: