Provider Demographics
NPI:1356034771
Name:MOHR, NICHOLE (LSAA)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:MOHR
Suffix:
Gender:F
Credentials:LSAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 32ND STREET BYP
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7802
Mailing Address - Country:US
Mailing Address - Phone:575-597-2650
Mailing Address - Fax:575-597-2651
Practice Address - Street 1:3200 32ND STREET BYP
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7802
Practice Address - Country:US
Practice Address - Phone:575-597-2650
Practice Address - Fax:575-597-2651
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCBT-2023-0396101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)