Provider Demographics
NPI:1730688557
Name:SEARS COUNSELING LLC
Entity type:Organization
Organization Name:SEARS COUNSELING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:ARACELI
Authorized Official - Last Name:SEARS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-649-4167
Mailing Address - Street 1:1611 AGUA DULCE DR SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8748
Mailing Address - Country:US
Mailing Address - Phone:575-649-4167
Mailing Address - Fax:
Practice Address - Street 1:1100 S. MAIN STREET SUITE 22
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-8800
Practice Address - Country:US
Practice Address - Phone:575-649-4167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03328126002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27826252Medicaid