Healthcare Provider Details

I. General information

NPI: 1003789876
Provider Name (Legal Business Name): LULA KELHOYOUMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 BIA ROUTE 114
PINEHILL NM
87357-0362
US

IV. Provider business mailing address

PO BOX 362
PINEHILL NM
87357-0362
US

V. Phone/Fax

Practice location:
  • Phone: 505-415-5491
  • Fax:
Mailing address:
  • Phone: 505-415-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: