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General NPI Number Information
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NPI Number | 1710313655
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Entity Type | Organization
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Legal Business Name | AXIS 5 COUNSELING INC.
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Dates
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Enumeration Date | 09/24/2013
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 333 E. MAIN ST. STE. 240
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-327-9145
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Fax | 505-327-9147
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Provider Business Mailing Address
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Address Line | 333 E. MAIN ST. STE. 240
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-327-9145
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Fax | 505-327-9147
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | SHARON K HOWELL
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Credential | RN LISW
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Telephone | 505-947-9357
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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 | 1-08394
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License Number State | NM
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