Healthcare Provider Details

I. General information

NPI: 1518521640
Provider Name (Legal Business Name): RUTH ANN ORDONEZ LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

155 CALLE OJO FELIZ UNIT C
SANTA FE NM
87505-5789
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-5006
  • Fax:
Mailing address:
  • Phone: 505-919-9222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0213641
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: