Healthcare Provider Details

I. General information

NPI: 1942321666
Provider Name (Legal Business Name): LISA J RUPARD L.I.S.W., CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N DATE ST
TRUTH OR CONSEQUENCES NM
87901-2824
US

IV. Provider business mailing address

617 KRUGER ST
TRUTH OR CONSEQUENCES NM
87901-2015
US

V. Phone/Fax

Practice location:
  • Phone: 575-894-8350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-05321
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: