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General NPI Number Information
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NPI Number | 1053839944
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Entity Type | Organization
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Legal Business Name | CLINICAL COUNSELING SERVICES
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 1123 VERMONT AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6340
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Country | US
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Telephone | 575-415-9270
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Fax | 208-978-7050
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Provider Business Mailing Address
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Address Line | 1617 ROSALIA LN
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6313
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Country | US
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Telephone | 575-415-9270
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Fax | 208-978-7050
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Authorized Official
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Title or Position | CLINICAL COUNSELOR
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Name | MARY ELIZABETH SAWYERS
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Credential | MA, LPCC
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Telephone | 575-415-9270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0093781
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License Number State | NM
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