Healthcare Provider Details

I. General information

NPI: 1225172471
Provider Name (Legal Business Name): PENNI LANE SEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 IVY ST
TRUTH OR CONSEQUENCES NM
87901-1634
US

IV. Provider business mailing address

611 KOPRA ST
TRUTH OR CONSEQUENCES NM
87901-1649
US

V. Phone/Fax

Practice location:
  • Phone: 575-496-8174
  • Fax:
Mailing address:
  • Phone: 575-496-8174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0106931
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0111001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: