NPIMap

Organization Active NPI

Beverly Michael

  • Community/Behavioral Health Agency
  • Grants, NM
National Provider Identifier
1295910065
Registry record updated Jul 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
03-074959-00-0 Issued in NM
Legal business name
BEVERLY MICHAEL
Practice address
1109 Mesa Blvd
Suite D
Grants, NM 87020-3038
Phone
(505) 287-3773
Fax
(505) 287-5115
NPI assigned
Dec 29, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Beverly Michael, LISWNPI 1336263656
Title
Owner/Operator
Phone
(505) 287-3773

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 03-074959-00-0 NM Primary

Addresses

Primary practice location

1109 Mesa Blvd
Suite D
Grants, NM 87020-3038

Mailing address

1109 Mesa Blvd
Suite D
Grants, NM 87020-3038
Phone (505) 287-3773

Other identifiers 1

IdentifierTypeStateIssuer
24331350MedicaidNM

Other names 1

  • Sierra Vista Counseling Doing business as

National Provider Directory

National Provider Directory

Locations

1109 Mesa Blvd
Ste D
Grants, NM 87020
Phone (505) 287-3773

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1198886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215388800000",
    "number": "1295910065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 MESA BLVD",
            "address_2": "SUITE D",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870203038",
            "telephone_number": "505-287-3773",
            "fax_number": "505-287-5115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 MESA BLVD",
            "address_2": "SUITE D",
            "city": "GRANTS",
            "state": "NM",
            "postal_code": "870203038",
            "telephone_number": "505-287-3773",
            "fax_number": "505-287-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY MICHAEL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-29",
        "last_updated": "2008-07-07",
        "status": "A",
        "authorized_official_last_name": "MICHAEL",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "OWNER/OPERATOR",
        "authorized_official_telephone_number": "505-287-3773",
        "authorized_official_credential": "LISW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NM",
            "license": "03-074959-00-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "24331350",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Vista Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grants, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.