Provider Demographics
NPI:1770941486
Name:SIERRA BLANCA COUNSELING
Entity type:Organization
Organization Name:SIERRA BLANCA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-491-3300
Mailing Address - Street 1:2904 SUDDERTH DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6338
Mailing Address - Country:US
Mailing Address - Phone:575-491-3300
Mailing Address - Fax:844-876-6786
Practice Address - Street 1:2904 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6338
Practice Address - Country:US
Practice Address - Phone:575-491-3300
Practice Address - Fax:844-876-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1235393182OtherNPI
NM1013288208Medicaid
NM23700386Medicaid
NM1720416795OtherNPI