Provider Demographics
NPI:1598229627
Name:ANDERSON-MARTIN LLC
Entity Type:Organization
Organization Name:ANDERSON-MARTIN LLC
Other - Org Name:ANDERSON-MARTIN LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:ANDERSON - MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-496-4327
Mailing Address - Street 1:2195 SHADY PL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4567
Mailing Address - Country:US
Mailing Address - Phone:575-496-4327
Mailing Address - Fax:
Practice Address - Street 1:2195 SHADY PL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4567
Practice Address - Country:US
Practice Address - Phone:915-300-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)