Basic Information
| Provider Information | |||||||||
| NPI: | 1437351962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCHLABACH | ||||||||
| FirstName: | PRISCILLA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LISW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KELLEY | ||||||||
| OtherFirstName: | PRISCILLA | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1349 | ||||||||
| Address2: | BORDER AREA MENTAL HEALTH SERVICE | ||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880621349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884497 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 S HUDSON ST | ||||||||
| Address2: | BORDER AREA MENTAL HEALTH SERVICES, INC. | ||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880616184 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753884412 | ||||||||
| FaxNumber: | 5755341150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 07/20/2011 | ||||||||
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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 | 1041C0700X | 3128 | OK | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 1-07704 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3128 | 01 | OK | STATE OF OKLAHOMA | OTHER | I-07704 | 01 | NM | STATE OF NEW MEXICO | OTHER |