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General NPI Number Information
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NPI Number | 1114139565
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Entity Type | Organization
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Legal Business Name | COKATA LTD. LIABILITY COMPANY
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 138 RIDGECREST DR
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City | SANTA FE
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State | NM
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Zip | 87505-6343
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Country | US
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Telephone | 505-471-9154
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Fax | 505-438-9592
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Provider Business Mailing Address
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Address Line | 138 RIDGECREST DR
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City | SANTA FE
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State | NM
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Zip | 87505-6343
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Country | US
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Telephone | 505-471-9154
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Fax | 505-438-9592
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Authorized Official
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Title or Position | CO-MANAGER
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Name | MR. RONALD LEE ANDES
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Credential | LPC
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Telephone | 505-438-9592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC0915
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License Number State | NM
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