Healthcare Provider Details

I. General information

NPI: 1689094302
Provider Name (Legal Business Name): LINDSEY IRENE RENFRO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EAST NINTH AVENUE SIERRA VISTA COUNSELING CENTER
TRUTH OR CONSEQUENCES NM
87901
US

IV. Provider business mailing address

800 EAST NINTH AVENUE SIERRA VISTA COUNSELING CENTER
TRUTH OR CONSEQUENCES NM
87901
US

V. Phone/Fax

Practice location:
  • Phone: 575-743-1380
  • Fax: 575-743-1362
Mailing address:
  • Phone: 575-743-1380
  • Fax: 575-743-1362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-08286
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: