Healthcare Provider Details

I. General information

NPI: 1912653163
Provider Name (Legal Business Name): LORETTA S OHMAYE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 MIGUEL CHAVEZ BLDG. A, STE B
SANTA FE NM
87505
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 Number
License Number State

VIII. Authorized Official

Name: LORETTA (LARA) OHMAYE
Title or Position: OWNER/COUNSELOR
Credential: LPCC
Phone: 505-930-0186