| White Horse Studio, Llc | |
|
2410 S Espina St Las Cruces NM 88001-5612 | |
| (915) 588-7290 | |
| (575) 613-7243 |
| Full Name | White Horse Studio, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2410 S Espina St, Las Cruces, New Mexico |
| Authorized Official Name and Position | Donna Gallegos (CREDENTIALLING) |
| Authorized Official Contact | 5752020750 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| White Horse Studio, Llc 135 Whittington Pl Anthony NM 88021-9270 Ph: (915) 588-7290 | White Horse Studio, Llc 2410 S Espina St Las Cruces NM 88001-5612 Ph: (915) 588-7290 |
| NPI Number | 1376035873 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 05/31/2018 |
| Medicare PECOS PAC ID | 4183989577 |
|---|---|
| Medicare Enrollment ID | O20180606002019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376035873 | NPI | - | NPPES |
| 54886368 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 104100000X | Social Worker | C-05502 (New Mexico) | Primary |
| Provider Name | Teri Allen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922322403 PECOS PAC ID: 3577715267 Enrollment ID: I20121203000463 |
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