Healthcare Provider Details

I. General information

NPI: 1760049407
Provider Name (Legal Business Name): OAK TREE COUNSELING & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W HIGH ST STE F
GRANTS NM
87020-2566
US

IV. Provider business mailing address

60025 CANTINA ACRES
GRANTS NM
87020-9644
US

V. Phone/Fax

Practice location:
  • Phone: 505-658-0052
  • Fax: 505-565-7712
Mailing address:
  • Phone: 505-658-0052
  • Fax: 505-565-7712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNESSA MARIE VALDEZ SIMPKINS
Title or Position: MANAGING MEMBER/BH PROVIDER
Credential: LPCC
Phone: 505-658-0052