Provider Demographics
NPI:1073745451
Name:HEARD, BOBBY S (LCSW)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:S
Last Name:HEARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:BOBBY
Other - Middle Name:
Other - Last Name:HEARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADAC
Mailing Address - Street 1:3978 S SPRING LOOP
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-9625
Mailing Address - Country:US
Mailing Address - Phone:575-626-2241
Mailing Address - Fax:
Practice Address - Street 1:110 E MESCALERO RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6542
Practice Address - Country:US
Practice Address - Phone:575-623-1480
Practice Address - Fax:575-622-3325
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0111741101YA0400X
NMI-081891041C0700X
NMC-081891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)