Healthcare Provider Details

I. General information

NPI: 1215863196
Provider Name (Legal Business Name): CANYON CALM COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BARBARA LP SE SUITE G
RIO RANCHO NM
87124-1088
US

IV. Provider business mailing address

1430 WILKES WAY SE
RIO RANCHO NM
87124-0991
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-8486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHAWN O'CONNELL
Title or Position: OWNER
Credential: LPCC
Phone: 505-263-6291