Healthcare Provider Details

I. General information

NPI: 1609467455
Provider Name (Legal Business Name): GUIDED COURAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 GRAL TREVINO DR SE
RIO RANCHO NM
87124-1202
US

IV. Provider business mailing address

PO BOX 15402
RIO RANCHO NM
87174-0402
US

V. Phone/Fax

Practice location:
  • Phone: 505-278-0050
  • Fax:
Mailing address:
  • Phone: 505-278-0050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: NATASHA MOHARTER
Title or Position: OWNER, CEO
Credential: MA, LPCC, NCC
Phone: 505-278-0050