Healthcare Provider Details

I. General information

NPI: 1003280314
Provider Name (Legal Business Name): FRANCINE ANAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 VAROS LN
EL PRADO NM
87529-4100
US

IV. Provider business mailing address

1331 GUSDORF RD
TAOS NM
87571-6282
US

V. Phone/Fax

Practice location:
  • Phone: 575-770-5104
  • Fax:
Mailing address:
  • Phone: 575-770-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1777
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: