Healthcare Provider Details

I. General information

NPI: 1053987941
Provider Name (Legal Business Name): MICHELLE N ERWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E HIGH ST
TUCUMCARI NM
88401-2726
US

IV. Provider business mailing address

402 S 3RD ST
SAN JON NM
88434-8707
US

V. Phone/Fax

Practice location:
  • Phone: 575-461-6200
  • Fax:
Mailing address:
  • Phone: 575-403-4503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0630
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: