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General NPI Number Information
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NPI Number | 1306323555
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Entity Type | Organization
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Legal Business Name | LITANY OF LIFE
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Dates
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Enumeration Date | 07/20/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 1010 RIDGEWAY PLACE
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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 | 505-327-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 B SMITH LANE
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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 | 505-635-1215
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Fax |
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Authorized Official
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Title or Position | OWNER/CEO
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Name | KAREN JEAN KAVALOSKI
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Credential | LPCC
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Telephone | 505-635-1215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CCMH0197151
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CCMH0197151
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CCMH0197151
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CCMH0197151
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License Number State | NM
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