Healthcare Provider Details

I. General information

NPI: 1003692278
Provider Name (Legal Business Name): NEW MEXICO COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 SANDOVAL DR NE
RIO RANCHO NM
87144-5152
US

IV. Provider business mailing address

5880 SANDOVAL DR NE
RIO RANCHO NM
87144-5152
US

V. Phone/Fax

Practice location:
  • Phone: 505-220-6528
  • Fax:
Mailing address:
  • Phone: 505-220-6528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: OLIVER MATTHEW GALLEGOS
Title or Position: OWNER
Credential: LPCC
Phone: 505-220-6528