| Vista Clara Counseling Llc | |
|
2005 Rt 66 W Suite F Moriarty NM 87035 | |
| (505) 433-8822 | |
| Not Available |
| Full Name | Vista Clara Counseling Llc |
|---|---|
| Speciality | Counselor |
| Location | 2005 Rt 66 W, Moriarty, New Mexico |
| Authorized Official Name and Position | Sara Sadie Lombardi (OWNER/MANAGER) |
| Authorized Official Contact | 5054338822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vista Clara Counseling Llc Po Box 2732 Moriarty NM 87035-2732 Ph: (505) 433-8822 | Vista Clara Counseling Llc 2005 Rt 66 W Suite F Moriarty NM 87035 Ph: (505) 433-8822 |
| NPI Number | 1114690443 |
|---|---|
| Provider Enumeration Date | 08/02/2021 |
| Last Update Date | 08/02/2021 |
| Certification Date | 06/09/2021 |
| Medicare PECOS PAC ID | 1456739135 |
|---|---|
| Medicare Enrollment ID | O20220608002562 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114690443 | NPI | - | NPPES |
| 77179579 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
| Provider Name | Kelly S Dickson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023241924 PECOS PAC ID: 1052668548 Enrollment ID: I20180713002448 |
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