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General NPI Number Information
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NPI Number | 1679313464
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Entity Type | Organization
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Legal Business Name | POSITIVE POTENTIAL NM
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 05/29/2024
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Provider Practice Location Address
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Address Line | 4011 BARBARA LOOP SE STE 206A
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City | RIO RANCHO
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State | NM
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Zip | 87124-1041
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Country | US
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Telephone | 505-796-2356
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Fax |
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Provider Business Mailing Address
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Address Line | 105 SUGAR RIDGE LOOP SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-4312
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO OWNER
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Name | TRENT JOHN
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Credential |
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Telephone | 505-796-2356
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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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