MEDICARE: NEW MEXICO COUNSELING ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003692278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO COUNSELING ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	5880 SANDOVAL DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5152
Country	:	US
Telephone Number	:	505-220-6528
Fax Number	:

Provider Business Practice Location Address
First Line	:	5880 SANDOVAL DR NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-5152
Country	:	US
Telephone Number	:	505-220-6528
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	OLIVER MATTHEW GALLEGOS
Credential	:	LPCC
Telephone Number	:	505-220-6528

Provider Enumeration Date	:	09/05/2023
Last Update Date	:	11/14/2023

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