| Doctor Name: | KRISTENE C. SHERYL |
| NPI Number: | 1265601652 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADAC |
| License Number: | 0110461 |
| Business Practice Address: | 332 E. Motel Drive Lordsburg, NM - 88045 |
| Business Phone Number: | 5755423304 |
| Business Fax Number: | 5755423305 |
| Mailing Address: | 1320 S. Solano, LAS CRUCES |
| State: | NM |
| Postal Code: | 88001 |
| Phone Number: | 5755277900 |
| Fax Number: | 5755714872 |
| NPI Enumeration Date: | 02/29/2008 |
| NPI Last Update Date: | 03/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 0110461 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |