Healthcare Provider Details

I. General information

NPI: 1659504934
Provider Name (Legal Business Name): MUTSUMI SHOJI LPCC, LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 S SAINT FRANCIS DR
SANTA FE NM
87505-4052
US

IV. Provider business mailing address

2718 CALLE CEDRO
SANTA FE NM
87505-5297
US

V. Phone/Fax

Practice location:
  • Phone: 505-316-5838
  • Fax: 972-736-2271
Mailing address:
  • Phone: 505-690-9317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0124501
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0124501
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0124501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: