Active NPI
Cheryl Ann Black, PH.D
- Counseling Psychologist
- Las Cruces, NM
National Provider Identifier
1174650477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 647
- Practice address
- 1890 Vista Sierra CT
Las Cruces, NM 88005-4653 - Phone
- (575) 639-4200
- Fax
- (575) 523-7106
- NPI assigned
- Feb 27, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 647 | NM | |
| Counseling Psychologist | 103TC1900X | 647 | NM | Primary |
Addresses
Primary practice location
1890 Vista Sierra CT
Las Cruces, NM 88005-4653
Mailing address
1890 Vista Sierra CT
Las Cruces, NM 88005-4653
Phone (575) 639-4200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J1735 | Medicaid | NM |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 647 | NM | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437696000000",
"number": "1174650477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1890 VISTA SIERRA CT",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880054653",
"telephone_number": "575-639-4200",
"fax_number": "575-523-7106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1890 VISTA SIERRA CT",
"city": "LAS CRUCES",
"state": "NM",
"postal_code": "880054653",
"telephone_number": "575-639-4200",
"fax_number": "575-523-7106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "CHERYL",
"middle_name": "ANN",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-27",
"last_updated": "2015-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "NM",
"license": "647",
"primary": false
},
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "NM",
"license": "647",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "J1735",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Cruces, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.