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General NPI Number Information
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NPI Number | 1902047160
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Entity Type | Organization
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Legal Business Name | SIERRA VISTA COUNSELING, LLC
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Dates
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Enumeration Date | 03/18/2009
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 1109 MESA BLVD SUITE D
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City | GRANTS
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State | NM
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Zip | 87020-3038
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Country | US
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Telephone | 505-287-3773
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Fax | 505-287-5011
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Provider Business Mailing Address
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Address Line | 1109 MESA BLVD SUITE D
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City | GRANTS
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State | NM
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Zip | 87020-3038
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Country | US
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Telephone | 505-287-3773
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Fax | 505-287-5011
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Authorized Official
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Title or Position | CO-OWNER/DIRECTOR
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Name | BEVERLY MICHAEL
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Credential | LISW
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Telephone | 505-287-3773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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