Provider Demographics
NPI:1598270399
Name:MOYERS, SHANTELL (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:MOYERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 N 10TH STREET
Mailing Address - Street 2:PO BOX 349
Mailing Address - City:FORT SUMNER
Mailing Address - State:NM
Mailing Address - Zip Code:88119
Mailing Address - Country:US
Mailing Address - Phone:575-355-2444
Mailing Address - Fax:
Practice Address - Street 1:546 N 10TH STREET
Practice Address - Street 2:
Practice Address - City:FORT SUMNER
Practice Address - State:NM
Practice Address - Zip Code:88119-0349
Practice Address - Country:US
Practice Address - Phone:575-355-2444
Practice Address - Fax:575-355-2444
Is Sole Proprietor?:No
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-09849101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health