MEDICARE: REFUGE COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0160971	NM

General Provider Information

NPI Number	:	1821532219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REFUGE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	3425 PUEBLO DR
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3425 PUEBLO DR
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2168
Country	:	US
Telephone Number	:	505-238-4143
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT/OWNER
Name	:	DIANA STEARNS
Credential	:	LMFT
Telephone Number	:	505-238-4143

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	12/05/2016

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