Healthcare Provider Details

I. General information

NPI: 1376640615
Provider Name (Legal Business Name): ANA M GULDAN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W PUEBLO DR
ESPANOLA NM
87532-2508
US

IV. Provider business mailing address

PO BOX 64
ALCALDE NM
87511-0064
US

V. Phone/Fax

Practice location:
  • Phone: 505-747-3368
  • Fax:
Mailing address:
  • Phone: 505-927-6587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0109881
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: