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General NPI Number Information
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NPI Number | 1306565569
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Entity Type | Organization
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Legal Business Name | HIDDEN VALLEY COUNSELING LLC
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 25 WAPITI LOOP VALLE ESCONDIDO
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 575-779-1484
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3139
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City | TAOS
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State | NM
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Zip | 87571-3139
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Country | US
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Telephone | 575-779-1484
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Fax |
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Authorized Official
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Title or Position | THERAPIST/COUNSELOR
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Name | LARISSA MARI WEINMAN
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Credential | LPCC
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Telephone | 575-779-1484
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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 |
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License Number State |
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