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General NPI Number Information
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NPI Number | 1285177675
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Entity Type | Organization
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Legal Business Name | OR FACTOR
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Dates
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Enumeration Date | 12/02/2016
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 400 N PENNSYLVANIA AVE STE 670C
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City | ROSWELL
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State | NM
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Zip | 88201-4755
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Country | US
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Telephone | 575-420-7336
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Fax | 575-627-5721
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Provider Business Mailing Address
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Address Line | 400 N PENNSYLVANIA AVE STE 670C
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City | ROSWELL
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State | NM
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Zip | 88201-4755
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Country | US
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Telephone | 575-623-7336
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Fax | 575-623-7337
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY SHANNON BYRNE
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Credential | LCSW
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Telephone | 575-420-7336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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