Individual
SHAWNA L LARRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 N MAIN AVE, LOVINGTON, NM 88260-2813
(575) 396-6611
Mailing address
1600 N MAIN AVE, LOVINGTON, NM 88260-2813
(575) 396-6611
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CMH0221651
NM
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/22/2012
Last updated
02/03/2022
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