Healthcare Provider Details

I. General information

NPI: 1790446441
Provider Name (Legal Business Name): WHOLE LIFE SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MICHAEL AVE SW
LOS LUNAS NM
87031-7388
US

IV. Provider business mailing address

270 MICHAEL AVE SW
LOS LUNAS NM
87031-7388
US

V. Phone/Fax

Practice location:
  • Phone: 270-535-6764
  • Fax: 505-657-5666
Mailing address:
  • Phone: 270-535-6764
  • Fax: 505-657-5666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JACOB HAMLIN
Title or Position: OFFICER
Credential: LMFT
Phone: 270-535-6764