Roth-Wall, Priscilla
Roth-Wall, Priscilla is an sole proprietor health care provider with primary practice located at 3751 N Butler Ave Ste 115 , Farmington NM 87401-6425. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Roth-Wall, Priscilla can be contacted via phone (505) 787-2640.Contact Information
Primary practice address
3751 N Butler Ave Ste 115
Farmington NM 87401-6425
Phone: (505) 787-2640
Fax: (505) 787-2789
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical Child & Adolescent | 103TC2200X | PSY1470 | New Mexico |
| Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities | 103TM1800X | PSY1470 | New Mexico |
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY1470 | New Mexico |
Profile Details
| NPI number | 1457386963 |
|---|---|
| LBN Legal business name | Roth-Wall, Priscilla |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 12th, 2006 |
| Last updated | Apr 30th, 2020 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1457386963 | NPPES |
| New Mexico | Other | PSY1470 | PSYCHOLOGY LICENSE |
| New Mexico | MEDICAID | 16970748 | PSYCHOLOGY LICENSE |
| New Mexico | Other | 73763700 | PSYCHOLOGY LICENSE |
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