| Sierra Blanca Counseling | |
|
2904 Sudderth Dr Ruidoso NM 88345-6338 | |
| (575) 491-3300 | |
| (844) 876-6786 |
| Full Name | Sierra Blanca Counseling |
|---|---|
| Speciality | Counselor |
| Location | 2904 Sudderth Dr, Ruidoso, New Mexico |
| Authorized Official Name and Position | Emily J Fleming (OWNER/THERAPIST) |
| Authorized Official Contact | 5754913300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sierra Blanca Counseling 2904 Sudderth Dr Ruidoso NM 88345-6338 Ph: (575) 491-3300 | Sierra Blanca Counseling 2904 Sudderth Dr Ruidoso NM 88345-6338 Ph: (575) 491-3300 |
| NPI Number | 1770941486 |
|---|---|
| Provider Enumeration Date | 02/09/2016 |
| Last Update Date | 07/20/2020 |
| Certification Date | 07/20/2020 |
| Medicare PECOS PAC ID | 3577995760 |
|---|---|
| Medicare Enrollment ID | O20191108000742 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770941486 | NPI | - | NPPES |
| 1235393182 | Other | NM | NPI |
| 1013288208 | Medicaid | NM | |
| 23700386 | Medicaid | NM | |
| 1720416795 | Other | NM | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 6864 (New Mexico) | Primary |
| Provider Name | Cheryl Lynne Moore |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598320236 PECOS PAC ID: 2961834163 Enrollment ID: I20191108001166 |
| Provider Name | Kimberly Denise Wudarzewski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720416795 PECOS PAC ID: 5890127021 Enrollment ID: I20191108002415 |
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