Healthcare Provider Details

I. General information

NPI: 1457011637
Provider Name (Legal Business Name): RESTORATIVE PATHS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 BARBARA LOOP SE STE 103
RIO RANCHO NM
87124-1040
US

IV. Provider business mailing address

4011 BARBARA LOOP SE STE 103
RIO RANCHO NM
87124-1040
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-9347
  • Fax:
Mailing address:
  • Phone: 505-249-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THOMAS ANTHONY TRUJILLO
Title or Position: PARTNER/OWNER
Credential: LMSW
Phone: 505-410-9588