| Equine Assisted Programs Of Southern New Mexico Llc | |
|
1911 Trails End Rd Las Cruces NM 88007-6059 | |
| (575) 888-7377 | |
| Not Available |
| Full Name | Equine Assisted Programs Of Southern New Mexico Llc |
|---|---|
| Speciality | Counselor |
| Location | 1911 Trails End Rd, Las Cruces, New Mexico |
| Authorized Official Name and Position | Nancy Ann Marshall (CEO, MENTAL HEALTH COUNSELOR) |
| Authorized Official Contact | 5758887377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Equine Assisted Programs Of Southern New Mexico Llc 2521 N Main St Unit 1-116 Las Cruces NM 88001-1154 Ph: (575) 888-7377 | Equine Assisted Programs Of Southern New Mexico Llc 1911 Trails End Rd Las Cruces NM 88007-6059 Ph: (575) 888-7377 |
| NPI Number | 1730698309 |
|---|---|
| Provider Enumeration Date | 09/26/2017 |
| Last Update Date | 07/21/2022 |
| Certification Date | 05/12/2021 |
| Medicare PECOS PAC ID | 4789913302 |
|---|---|
| Medicare Enrollment ID | O20190907000027 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730698309 | NPI | - | NPPES |
| 1073064028 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (New Mexico) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Kathleen Hollett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164797882 PECOS PAC ID: 5799014320 Enrollment ID: I20190909000067 |
| Provider Name | Anna Vigil |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790203479 PECOS PAC ID: 9032506779 Enrollment ID: I20220427000510 |
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