Provider Demographics
NPI:1417779430
Name:FRANK IGNACIO, SIERRA (MSW, LSAA, CADS)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:FRANK IGNACIO
Suffix:
Gender:F
Credentials:MSW, LSAA, CADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO 1830
Mailing Address - Street 2:
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420
Mailing Address - Country:US
Mailing Address - Phone:505-368-1452
Mailing Address - Fax:505-368-1461
Practice Address - Street 1:PINON AND COTTONWOOD DRIVE BLDG 2301
Practice Address - Street 2:
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCADS22005171100000X
NMCTB-2023-0093101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171100000XOther Service ProvidersAcupuncturist