Provider Demographics
NPI:1184689150
Name:BARD, CAROLYN J (PMHC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:J
Last Name:BARD
Suffix:
Gender:F
Credentials:PMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST NINTH STREET
Mailing Address - Street 2:SIERRA VISTA HOSPITAL COUNSELING CENTER
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901
Mailing Address - Country:US
Mailing Address - Phone:505-894-2111
Mailing Address - Fax:505-894-7659
Practice Address - Street 1:800 EAST NINTH STREET
Practice Address - Street 2:SIERRA VISTA HOSPITAL COUNSELING CENTER
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901
Practice Address - Country:US
Practice Address - Phone:505-894-2111
Practice Address - Fax:505-894-7659
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health