Provider Demographics
NPI:1295227866
Name:SALLY HUNTER LCSW LLC
Entity Type:Organization
Organization Name:SALLY HUNTER LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-250-3460
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:JEMEZ SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:87025-0156
Mailing Address - Country:US
Mailing Address - Phone:505-250-3460
Mailing Address - Fax:
Practice Address - Street 1:17570 NM 4
Practice Address - Street 2:
Practice Address - City:JEMEZ SPRINGS
Practice Address - State:NM
Practice Address - Zip Code:87025
Practice Address - Country:US
Practice Address - Phone:505-250-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-093741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty