Provider Demographics
NPI:1801994728
Name:NEW MEXICO PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:NEW MEXICO PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SHERRILL, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-327-7777
Mailing Address - Street 1:701 W APACHE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5511
Mailing Address - Country:US
Mailing Address - Phone:505-327-7777
Mailing Address - Fax:505-327-7779
Practice Address - Street 1:701 W APACHE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5511
Practice Address - Country:US
Practice Address - Phone:505-327-7777
Practice Address - Fax:505-327-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM142103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25747OtherPRESBYTERIAN HEALTH PLAN
NMN850OtherBLUE CROSS
NMN7935Medicaid
NM25-0550-7Medicare ID - Type Unspecified