Organization
SERVICE ORGANIZATION FOR YOUTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FERMAN ULIBARRI LMSW, LSAA (EXECUTIVE DIRECTOR)
(575) 445-8568
Entity
Organization
Contact information
Practice address
101 LETTON DR, RATON, NM 87740-4366
(575) 445-8568
(575) 445-0540
Mailing address
PO BOX 1165, RATON, NM 87740-1165
(575) 445-8568
(575) 445-0540
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-0172211
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71525564
—
NM
Enumeration date
02/11/2015
Last updated
02/11/2015
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