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General NPI Number Information
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NPI Number | 1770941486
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Entity Type | Organization
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Legal Business Name | SIERRA BLANCA COUNSELING
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Dates
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Enumeration Date | 02/09/2016
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 2904 SUDDERTH DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6338
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Country | US
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Telephone | 575-491-3300
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Fax | 844-876-6786
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Provider Business Mailing Address
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Address Line | 2904 SUDDERTH DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6338
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Country | US
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Telephone | 575-491-3300
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Fax | 844-876-6786
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | EMILY J FLEMING
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Credential | LPCC
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Telephone | 575-491-3300
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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 | 6864
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License Number State | NM
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