Provider Demographics
NPI:1073196127
Name:BOSMAN, ELLEN (MS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BOSMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 CORTABELLA
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-8234
Mailing Address - Country:US
Mailing Address - Phone:575-635-5379
Mailing Address - Fax:
Practice Address - Street 1:755 S TELSHOR BLVD STE Q102
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4681
Practice Address - Country:US
Practice Address - Phone:575-635-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist