Healthcare Provider Details

I. General information

NPI: 1053048264
Provider Name (Legal Business Name): ADRIANNA B SUAZO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2022
Last Update Date: 02/12/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SPRUCE ST STE C&D
ESPANOLA NM
87532-3455
US

IV. Provider business mailing address

PO BOX 535
DIXON NM
87527-0535
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-7400
  • Fax:
Mailing address:
  • Phone: 505-927-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2023-0059
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: