Micah Wolffarth
Individual provider Active NPI Counselor · Clayton, NM
NPI 1811243579 · NPPES record last updated Jun 13, 2014
Key facts
- NPI
- 1811243579
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 15 Oak St
Clayton, NM 88415-2530 - Phone
- (575) 374-8326
- Fax
- (575) 758-5860
- NPI assigned
- Jul 31, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | |||
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
15 Oak St
Clayton, NM 88415-2530
Mailing address
2551 Coors Blvd NW
Albuquerque, NM 87120-1213
Other providers in Clayton, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.