Healthcare Provider Details

I. General information

NPI: 1578083556
Provider Name (Legal Business Name): LORETTA SALOME OHMAYE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LARA SALOME OHMAYE LPCC

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 MIGUEL CHAVEZ RD BLDG A, STE B
SANTA FE NM
87505-6914
US

IV. Provider business mailing address

4 BRIMHALL WASH
SANTA FE NM
87508-4817
US

V. Phone/Fax

Practice location:
  • Phone: 505-930-0186
  • Fax:
Mailing address:
  • Phone: 505-930-0186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0192471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: