Organization
SIERRA VISTA COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY MICHAEL LISW (CO-OWNER/DIRECTOR)
(505) 287-3773
Entity
Organization
Contact information
Practice address
1109 MESA BLVD, SUITE D, GRANTS, NM 87020-3038
(505) 287-3773
(505) 287-5011
Mailing address
1109 MESA BLVD, SUITE D, GRANTS, NM 87020-3038
(505) 287-3773
(505) 287-5011
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24331350
—
NM
Enumeration date
03/18/2009
Last updated
07/24/2009
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