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General NPI Number Information
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NPI Number | 1255760153
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH INC.
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 11/01/2013
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Provider Practice Location Address
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Address Line | 3005 NORTHRIDGE STE.J
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City | FARMINGTON
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State | NM
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Zip | 87401
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Country | US
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Telephone | 505-564-8936
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Fax | 505-326-0172
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Provider Business Mailing Address
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Address Line | PO BOX 5502
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City | FARMINGTON
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State | NM
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Zip | 87499-5502
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Country | US
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Telephone | 505-564-8936
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Fax | 505-326-0172
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Authorized Official
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Title or Position | OWNER
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Name | LINDA WIEBE
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Credential |
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Telephone | 505-564-8936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0074
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License Number State | NM
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