Provider Demographics
NPI:1427617612
Name:KERRY NIEC MA LPCC
Entity type:Organization
Organization Name:KERRY NIEC MA LPCC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NIEC
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-426-7847
Mailing Address - Street 1:PO BOX 3772
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-6772
Mailing Address - Country:US
Mailing Address - Phone:505-426-7847
Mailing Address - Fax:
Practice Address - Street 1:2707 HOT SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4093
Practice Address - Country:US
Practice Address - Phone:505-426-7847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health