Organization
SOUTHERN COUNSELING AND PSYCHOLOGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS STEPHEN SOUTHERN PH.D. (PSYCHOLOGIST/OWNER)
(575) 420-1853
Entity
Organization
Contact information
Practice address
104 E LINDA VISTA BLVD STE B, ROSWELL, NM 88201-6667
(575) 624-8889
Mailing address
PO BOX 3391, ROSWELL, NM 88202-3391
(575) 624-8889
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1353
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10180087
—
NM
Enumeration date
01/08/2015
Last updated
03/17/2018
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