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General NPI Number Information
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NPI Number | 1528501079
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Entity Type | Individual
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Provider Name | EMILY FOSSUM LPCC
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Gender | Female
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 835 SPRUCE ST STE C&D
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City | ESPANOLA
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State | NM
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Zip | 87532-3455
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Country | US
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Telephone | 505-747-7400
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Fax | 505-747-7403
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Provider Business Mailing Address
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Address Line | 835 SPRUCE ST STE C&D
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City | ESPANOLA
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State | NM
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Zip | 87532-3455
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Country | US
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Telephone | 505-747-7400
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Fax | 505-747-7403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | CC01318
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CCMH0224041
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License Number State | NM
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