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NPI Code Detail

MEDICARE: SOL PSYCHOLOGICAL SERVICES

MEDICARE: SOL PSYCHOLOGICAL SERVICES
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
1101YM0800XMental Health Counselor0149851NM

General Provider Information

NPI Number : 1902307069
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOL PSYCHOLOGICAL SERVICES
Provider Business Mailing Address
First Line : 255 W HADLEY AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-1806
Country : US
Telephone Number : 434-996-6562
Fax Number :
Provider Business Practice Location Address
First Line : 255 W HADLEY AVE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88005-1806
Country : US
Telephone Number : 434-996-6562
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MS. ELIZABETH A BLACK
Credential : LPCC, NCSP
Telephone Number : 434-996-6562
Provider Enumeration Date : 02/23/2018
Last Update Date : 02/23/2018

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Directions to “SOL PSYCHOLOGICAL SERVICES ” Practice Location

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