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General NPI Number Information
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NPI Number | 1417546367
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Entity Type | Organization
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Legal Business Name | LIFE QUEST COUNSELING, LLC
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Dates
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Enumeration Date | 01/14/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 116 N WALL AVE
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City | FARMINGTON
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State | NM
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Zip | 87401-6916
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Country | US
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Telephone | 505-297-6616
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Fax | 505-787-2411
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Provider Business Mailing Address
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Address Line | PO BOX 5522
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City | FARMINGTON
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State | NM
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Zip | 87499-5522
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Country | US
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Telephone | 505-297-6166
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Fax | 505-787-2411
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Authorized Official
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Title or Position | OWNER
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Name | CRAIG SPENCER HUTTON
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Credential | LCSW
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Telephone | 505-297-6616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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