| Lisa Dykes-harrell, Llc | |
|
100 S Ave A Portales NM 88130-5917 | |
| (575) 749-3736 | |
| (575) 226-6892 |
| Full Name | Lisa Dykes-harrell, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 100 S Ave A, Portales, New Mexico |
| Authorized Official Name and Position | Lisa L. Dykes-harrell (COUNSELOR) |
| Authorized Official Contact | 5757493736 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Dykes-harrell, Llc 187 Nm 88 Portales NM 88130 Ph: (575) 749-3736 | Lisa Dykes-harrell, Llc 100 S Ave A Portales NM 88130-5917 Ph: (575) 749-3736 |
| NPI Number | 1881992311 |
|---|---|
| Provider Enumeration Date | 03/08/2011 |
| Last Update Date | 06/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881992311 | NPI | - | NPPES |
| 04850041 | Medicaid | NM | |
| 11783765 | Other | NM | CAQH |
| 1316956923 | Other | NM | SOLE PROPRIETER NPI 1316956923 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 005790 (New Mexico) | Primary |
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White Oaks Counseling, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1420 S Avenue O, Portales, NM 88130 Phone: 575-356-2347 Fax: 575-356-2347 | |
Southeastern Behavioral Associates, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 518 E 18th St # B, Portales, NM 88130 Phone: 575-714-3410 | |
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