Self-Discovery Recovery LLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

SELF-DISCOVERY RECOVERY LLC

Practice address

1052 Main St NE
Los Lunas, NM 87031-7436

Phone

(505) 603-8633

NPI assigned

Oct 20, 2023

Organization subpart

No

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

Authorized official

Name

Gerasimos Demosthenis Klonis, LPCCNPI 1548877855

Title

Manager

Phone

(505) 603-8633

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

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

• Gerasimos Demosthenis Klonis, LPCC

  • Professional Counselor
  • Socorro, NM
  • NPI 1548877855

  Mental Health

  NPD Authorized official

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

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705190400000",
    "number": "1497537658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 CLEAR SKY ST SW",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870316453",
            "telephone_number": "505-603-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1052 MAIN ST NE",
            "city": "LOS LUNAS",
            "state": "NM",
            "postal_code": "870317436",
            "telephone_number": "505-603-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-DISCOVERY RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2024-01-14",
        "certification_date": "2024-01-14",
        "status": "A",
        "authorized_official_last_name": "KLONIS",
        "authorized_official_first_name": "GERASIMOS",
        "authorized_official_middle_name": "DEMOSTHENIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "505-603-8633",
        "authorized_official_credential": "LPCC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19024576",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia J Sedillo
• Desiree Monique Sedillo
• Jason Carlos Sedillo
• John L. Sedillo
• Trina Marie Seifert, FNP-C
• Ashley Sena
• Senior Living Systems Inc.
• Therese Shafer, BMS
• Sumita Shankar
• Sarah E Shearin

• Professional Counselor in Los Lunas, NM
• Providers in Los Lunas, NM by specialty
• Professional Counselor in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2024; 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.