Healthcare Provider Details

I. General information

NPI: 1518773456
Provider Name (Legal Business Name): EMOTIONAL WELLNESS COUNSELING NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LENA ST BLDG C
SANTA FE NM
87505-3891
US

IV. Provider business mailing address

223 N GUADALUPE ST STE 822
SANTA FE NM
87501-1868
US

V. Phone/Fax

Practice location:
  • Phone: 405-314-0817
  • Fax: 505-557-6318
Mailing address:
  • Phone: 405-314-0817
  • Fax: 505-557-6381

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: CYNTHIA T MCCOY
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 405-314-0817