Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 0091171 | NM |
NPI | 1003089079 |
---|---|
Provider Name | Terry Barsano |
First Address | El Prado, NM 87529-9504 |
Second Address | El Prado, NM 87529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 10/04/2008 |