MEDICARE: LARUNI WITTY

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		NM

General Provider Information

NPI Number	:	1366273690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARUNI WITTY

Provider Business Mailing Address
First Line	:	2810 N SWAN ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-5853
Country	:	US
Telephone Number	:	575-956-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 N SILVER ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7286
Country	:	US
Telephone Number	:	575-956-2060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2024
Last Update Date	:	08/08/2024

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Directions to “ LARUNI WITTY ” Practice Location

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