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General NPI Number Information
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NPI Number | 1760049407
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Entity Type | Organization
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Legal Business Name | OAK TREE COUNSELING & WELLNESS, LLC
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Dates
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Enumeration Date | 05/28/2019
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Last Update Date | 05/28/2019
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Provider Practice Location Address
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Address Line | 310 W HIGH ST STE F
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City | GRANTS
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State | NM
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Zip | 87020-2566
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Country | US
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Telephone | 505-658-0052
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Fax | 505-565-7712
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Provider Business Mailing Address
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Address Line | 60025 CANTINA ACRES
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City | GRANTS
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State | NM
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Zip | 87020-9644
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Country | US
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Telephone | 505-658-0052
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Fax | 505-565-7712
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Authorized Official
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Title or Position | MANAGING MEMBER/BH PROVIDER
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Name | MRS. ANNESSA MARIE VALDEZ SIMPKINS
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Credential | LPCC
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Telephone | 505-658-0052
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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 |
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License Number State |
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