Provider Demographics
NPI:1629019567
Name:SPEIR-PHILLIPS, CHERYL (MA, LPCC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:SPEIR-PHILLIPS
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W COLLEGE AVE
Mailing Address - Street 2:SUITE # 19
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5002
Mailing Address - Country:US
Mailing Address - Phone:505-388-4100
Mailing Address - Fax:505-534-4000
Practice Address - Street 1:301 W COLLEGE AVE
Practice Address - Street 2:SUITE # 19
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5002
Practice Address - Country:US
Practice Address - Phone:505-388-4100
Practice Address - Fax:505-534-4000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34153551Medicaid