Basic Information
| Provider Information | |||||||||
| NPI: | 1215225867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCROGGIN | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | M | ||||||||
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| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 914 N CANAL ST | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882205110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5758854836 | ||||||||
| FaxNumber: | 5758879579 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 W MAIN ST STE A2 | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882103711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757468890 | ||||||||
| FaxNumber: | 5757462383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2011 | ||||||||
| LastUpdateDate: | 07/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | T-0139901 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.