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General NPI Number Information
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NPI Number | 1942548714
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Entity Type | Individual
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Provider Name | MAYA S FERNANDEZ LMHC
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 01/29/2013
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Provider Practice Location Address
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Address Line | 6666 4TH ST NW
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City | LOS RANCHOS
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State | NM
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Zip | 87107-6144
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Country | US
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Telephone | 505-230-8631
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Fax | 505-898-7288
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Provider Business Mailing Address
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Address Line | 538 REGINA RD NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-1530
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Country | US
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Telephone | 505-203-8631
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Fax | 505-898-7288
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0154951
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License Number State | NM
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