Healthcare Provider Details

I. General information

NPI: 1053838375
Provider Name (Legal Business Name): JOURNEY TO WELLNESS COUNSELING LOS LUNAS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 COURTHOUSE RD SE
LOS LUNAS NM
87031-9212
US

IV. Provider business mailing address

PO BOX 3372
LOS LUNAS NM
87031-3372
US

V. Phone/Fax

Practice location:
  • Phone: 505-944-6626
  • Fax: 505-359-3239
Mailing address:
  • Phone: 505-944-6626
  • Fax: 505-359-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0159661
License Number StateNM

VIII. Authorized Official

Name: EMMA ORTEGA
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPCC
Phone: 505-944-6626