Healthcare Provider Details

I. General information

NPI: 1578797361
Provider Name (Legal Business Name): MINK GENEREUX PRICE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 LOS LENTES RD SE
LOS LUNAS NM
87031-6831
US

IV. Provider business mailing address

428 LOS LENTES RD SE
LOS LUNAS NM
87031-6831
US

V. Phone/Fax

Practice location:
  • Phone: 505-865-3350
  • Fax: 505-865-4739
Mailing address:
  • Phone: 505-865-3350
  • Fax: 505-865-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0141621
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: