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General NPI Number Information
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NPI Number | 1780216648
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Entity Type | Individual
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Provider Name | RICKIE ISAIAH FIERRO LMHC
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Gender | Male
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Dates
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Enumeration Date | 02/09/2020
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Last Update Date | 02/18/2020
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Provider Practice Location Address
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Address Line | 1200 N PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532-2687
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Country | US
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Telephone | 505-747-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 SAWMILL RD APT 424
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City | SANTA FE
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State | NM
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Zip | 87505-5687
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Country | US
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Telephone | 505-204-9011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | T-CTL0208751
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License Number State | NM
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