Kristi Coddington, LCSW
Individual provider Active NPI Mental Health Counselor · Bloomfield, NM
NPI 1043865496 · NPPES record last updated Jan 8, 2021
Key facts
- NPI
- 1043865496
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- X-11109 (NM)
- Practice address
- 100 N Church St Ste B
Bloomfield, NM 87413-5754 - Phone
- (505) 333-7219
- NPI assigned
- Aug 2, 2019
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
100 N Church St
Suite B
Bloomfield, NM 87413-5754
Phone (505) 333-7219
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210316002183 | NM | Practitioner - Clinical Social Worker | 5294141297 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| X-11109 | NM | MD | Mental Health Counselor |
| C-11409 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Able Clinical Services Inc. | Clinical | Current |
Accepting new patients |
Locations
100 N Church St
Ste B
Bloomfield, NM 87413
Phone (505) 333-7219
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C-11409 | NM | |
| Mental Health Counselor | 101YM0800X | X-11109 | NM | Yes |
Addresses
Primary practice location
100 N Church St Ste B
Bloomfield, NM 87413-5754
Mailing address
504 N Church St
Bloomfield, NM 87413-5607
Phone (505) 402-1134
Other practice location 1
802 E Navajo St
Farmington, NM 87401-9119
Phone (505) 333-7219
Other practice location 2
1201 N 1st St
Bloomfield, NM 87413-5271
Phone (505) 634-3500
Other providers in Bloomfield, NM
- Deadra D. Carrillo
- Nancy Carter
- Isabella Chavez
- Michelle Childers-Beck
- Terre G Coberly
- Victoria D. Coe
- Cynthia Colson
- Sharon Flora Cooke
- Brandon Ira Crockett
- Telecia Crockett
All providers in Bloomfield, NM · Mental Health Counselor in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.