Lynetta Irene Sullivan

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

312 N Broadway St
Truth Or Consequences, NM 87901-2834

Phone

(575) 740-0719

NPI assigned

Jan 26, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mountain Movers Family Therapy, PC

  • Marriage & Family Therapist
  • Truth Or Consequences, NM
  • NPI 1669101978
  NPD

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

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738627200000",
    "number": "1508519935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 N BROADWAY ST",
            "city": "TRUTH OR CONSEQUENCES",
            "state": "NM",
            "postal_code": "879012834",
            "telephone_number": "575-740-0719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 N BROADWAY ST",
            "city": "TRUTH OR CONSEQUENCES",
            "state": "NM",
            "postal_code": "879012834",
            "telephone_number": "575-740-0719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "LYNETTA",
        "middle_name": "IRENE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-26",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• State of New Mexico
• State of New Mexico
• State of New Mexico
• State of New Mexico
• Deborah Ann Stubblefield, RCP
• Leslie Summerlin, PHARMD
• T Or C Eye Clinic
• T Or C Physical Therapy
• Yolanda Tafoya, BCH, CCHW, CCSS
• Daniel Terrazas

• Community Health Worker in Truth Or Consequences, NM
• Providers in Truth Or Consequences, NM by specialty
• Community Health Worker in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; 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.