Healthcare Provider Details

I. General information

NPI: 1477626299
Provider Name (Legal Business Name): AMY LYN MOLINA ED.S, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LYN TREVINO ED.S, LPCC

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 SPRUCE AVE SPC 98
LAS CRUCES NM
88001-2471
US

IV. Provider business mailing address

PO BOX 1993
LAS CRUCES NM
88004-1993
US

V. Phone/Fax

Practice location:
  • Phone: 575-644-9209
  • Fax:
Mailing address:
  • Phone: 575-644-9209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0116921
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0116921
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: