MEDICARE: COLLETTE CEBALLES MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1760120521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLETTE CEBALLES MS

Provider Business Mailing Address
First Line	:	619 N ALAMEDA BLVD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2130
Country	:	US
Telephone Number	:	575-405-7146
Fax Number	:	575-405-5446

Provider Business Practice Location Address
First Line	:	304 W GRIGGS AVE STE C
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2603
Country	:	US
Telephone Number	:	575-405-7146
Fax Number	:	575-405-5446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “ COLLETTE CEBALLES MS” Practice Location

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