Healthcare Provider Details

I. General information

NPI: 1497455406
Provider Name (Legal Business Name): MUTSUMI SHOJI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
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: 505-316-5838
  • Fax: 972-736-2271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MUTSUMI SHOJI
Title or Position: OWNER
Credential: LPCC
Phone: 505-316-5838