Provider Demographics
NPI:1467662015
Name:FRANCIS, PEGGY ANN (MS, LADAC,CADS,LMHC)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:MS, LADAC,CADS,LMHC
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LADAC,CADS,LMHC
Mailing Address - Street 1:PO BOX 1830
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420-1830
Mailing Address - Country:US
Mailing Address - Phone:505-368-1438
Mailing Address - Fax:505-368-1452
Practice Address - Street 1:HWY 491 NORTH PINON ST.
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420-1830
Practice Address - Country:US
Practice Address - Phone:505-368-1438
Practice Address - Fax:505-368-1452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0203831101YM0800X
NM0062773245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health