Healthcare Provider Details

I. General information

NPI: 1316891823
Provider Name (Legal Business Name): JONATHAN SAMUEL MUNOZ LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N VIRGINIA AVE
ROSWELL NM
88201-5126
US

IV. Provider business mailing address

407 TIERRA BERRENDA DR
ROSWELL NM
88201-7837
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-9322
  • Fax:
Mailing address:
  • Phone: 575-910-8008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2026-0167
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: