Healthcare Provider Details

I. General information

NPI: 1558220814
Provider Name (Legal Business Name): CLARISSA RENEE QUINTANA LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 N MAIN ST
CLOVIS NM
88101-5932
US

IV. Provider business mailing address

PO BOX 19000
CLOVIS NM
88102-9000
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-4490
  • Fax: 575-769-4541
Mailing address:
  • Phone: 575-769-4490
  • Fax: 575-769-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0311
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: