MEDICARE: MUTSUMI SHOJI LPCC, LPAT

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	101Y00000X	Counselor	0124501	NM
2	101YP2500X	Professional Counselor	0124501	NM
3	101YM0800X	Mental Health Counselor	0124501	NM

General Provider Information

NPI Number	:	1659504934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUTSUMI SHOJI LPCC, LPAT

Provider Business Mailing Address
First Line	:	2718 CALLE CEDRO
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-5297
Country	:	US
Telephone Number	:	505-690-9317
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-4052
Country	:	US
Telephone Number	:	505-316-5838
Fax Number	:	972-736-2271

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

Provider Enumeration Date	:	09/02/2009
Last Update Date	:	03/08/2023

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