| Brooke Coffey, | |
|
813 Road 2900, Aztec, NM 87410-9760 | |
| (484) 364-1503 | |
| (484) 364-1503 |
| Full Name | Brooke Coffey |
|---|---|
| Gender | Female |
| Speciality | Counselor - Professional |
| Location | 813 Road 2900, Aztec, New Mexico |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043691546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | .0015743 (Colorado) | Primary |
| Entity Name | Sondermind Provider Network Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1760854442 PECOS PAC ID: 9537572490 Enrollment ID: O20210113002826 |
| Mailing Address | Practice Location Address |
|---|---|
| Brooke Coffey, 813 Road 2900, Aztec, NM 87410-9760 Ph: (484) 364-1503 | Brooke Coffey, 813 Road 2900, Aztec, NM 87410-9760 Ph: (484) 364-1503 |
Glynnis Pellett Urban, CMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 1118 W Aztec Blvd, Aztec, NM 87410 Phone: 505-334-3695 Fax: 505-599-4388 | |
Elise Martinez, LCSW Counselor Medicare: Medicare Enrolled Practice Location: 455 N Light Plant Rd, Aztec, NM 87410 Phone: 505-419-7913 | |
Ms. Jennifer Jane Mckinney, MA, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 457c Road 3000, Aztec, NM 87410 Phone: 505-801-7075 | |
Patricia Diane Fordyce-montanari, LMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 11 County Road 2952, Aztec, NM 87410 Phone: 505-333-2334 | |
Amanda Clearwater, LADAC Counselor Medicare: Not Enrolled in Medicare Practice Location: 663 Hampton Canyon Rd, Aztec, NM 87410 Phone: 505-217-6834 | |
Josephine Snyder Olson, LPCC Counselor Medicare: Not Enrolled in Medicare Practice Location: 106 S Main Ave, Aztec, NM 87410 Phone: 505-334-4919 Fax: 505-334-4916 |