Provider Demographics
NPI:1265674154
Name:VON ERFFA, SALLY BELLE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:BELLE
Last Name:VON ERFFA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 LOS RANCHOS RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6532
Mailing Address - Country:US
Mailing Address - Phone:505-252-6797
Mailing Address - Fax:
Practice Address - Street 1:7013 4TH ST NW STE C
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6639
Practice Address - Country:US
Practice Address - Phone:505-356-2200
Practice Address - Fax:844-272-7030
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60533946101YM0800X
CAMFC# 47140106H00000X
NMCMF0200791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health