Provider Demographics
NPI:1710313655
Name:AXIS 5 COUNSELING INC.
Entity Type:Organization
Organization Name:AXIS 5 COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN LISW
Authorized Official - Phone:505-947-9357
Mailing Address - Street 1:333 E. MAIN ST.
Mailing Address - Street 2:STE. 240
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:505-327-9145
Mailing Address - Fax:505-327-9147
Practice Address - Street 1:333 E. MAIN ST.
Practice Address - Street 2:STE. 240
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-327-9145
Practice Address - Fax:505-327-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-083941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty