Provider Demographics
NPI:1285279562
Name:SLOAN, JARED (LADAC, CADAC, NCAC I)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:SLOAN
Suffix:
Gender:M
Credentials:LADAC, CADAC, NCAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5403
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-5403
Mailing Address - Country:US
Mailing Address - Phone:575-391-1301
Mailing Address - Fax:575-391-1303
Practice Address - Street 1:107 S DALMONT ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-8428
Practice Address - Country:US
Practice Address - Phone:575-391-1301
Practice Address - Fax:575-391-1303
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0108681101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)