MEDICARE: LORETTA SALOME OHMAYE LPCC

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	101YP2500X	Professional Counselor	CCMH0192471	NM

General Provider Information

NPI Number	:	1578083556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORETTA SALOME OHMAYE LPCC

Provider Business Mailing Address
First Line	:	4 BRIMHALL WASH
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-4817
Country	:	US
Telephone Number	:	505-930-0186
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 MIGUEL CHAVEZ RD
Second Line	:	BLDG A, STE B
City	:	SANTA FE
State	:	NM
Zip	:	87505-6914
Country	:	US
Telephone Number	:	505-930-0186
Fax Number	:

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

Provider Enumeration Date	:	06/21/2017
Last Update Date	:	03/02/2022

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Directions to “ LORETTA SALOME OHMAYE LPCC” Practice Location

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