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General NPI Number Information
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NPI Number | 1669909537
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Entity Type | Organization
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Legal Business Name | ANA M GULDAN, MA, LPCC, LLC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 509 W PUEBLO DR
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City | ESPANOLA
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State | NM
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Zip | 87532-2508
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Country | US
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Telephone | 505-927-6587
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Fax | 505-367-0077
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Provider Business Mailing Address
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Address Line | PO BOX 64
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City | ALCALDE
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State | NM
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Zip | 87511-0064
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Country | US
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Telephone | 505-927-6587
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Fax | 505-367-0077
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Authorized Official
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Title or Position | OWNER
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Name | ANA MARTHA GULDAN
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Credential | LPCC
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Telephone | 505-927-6587
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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 | 0109881
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License Number State | NM
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