Organization
REGIONAL EDUCATIONAL CENTER #6
Active
Other names
San Jon School Based Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
PATTI HARRELSON (DIRECTOR)
(575) 562-4455
Entity
Organization
Contact information
Practice address
7TH & ELM STREET, SAN JON, NM 88434
(575) 576-2273
(575) 576-2273
Mailing address
PO BOX 847, PORTALES, NM 88130-0847
(575) 562-4455
(575) 562-4460
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NM
251300000X
Local Education Agency (LEA)
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
29371571
—
NM
Enumeration date
07/17/2012
Last updated
07/17/2012
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