Healthcare Provider Details

I. General information

NPI: 1023544061
Provider Name (Legal Business Name): VANESSA LYNN TORRES MCGOVERN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 ALEJANDRO ST
SANTA FE NM
87501-2379
US

IV. Provider business mailing address

409 ALEJANDRO ST
SANTA FE NM
87501-2379
US

V. Phone/Fax

Practice location:
  • Phone: 207-233-3169
  • Fax:
Mailing address:
  • Phone: 207-233-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0186811
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: