1821417171 NPI number — MS. SHIELA KAY WEEHUNT LPCC

Table of content: MS. SHIELA KAY WEEHUNT LPCC (NPI 1821417171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821417171 NPI number — MS. SHIELA KAY WEEHUNT LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEEHUNT
Provider First Name:
SHIELA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821417171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA LUZ
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88337-0148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-430-4804
Provider Business Mailing Address Fax Number:
575-439-9701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2474 INDIAN WELLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALAMOGORDO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88310-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-430-4804
Provider Business Practice Location Address Fax Number:
575-439-9701
Provider Enumeration Date:
04/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0184131 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18677037 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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