Manzano Mountain Counseling LLC

Organization Active NPI Mental Health Counselor · Estancia, NM

NPI 1619488608 · NPPES record last updated Jun 16, 2018

Key facts

NPI
1619488608
Entity type
Organization (NPI type 2)
Primary specialty
Mental Health Counselor 101YM0800X
License
C-09413 (NM)
Legal business name
MANZANO MOUNTAIN COUNSELING LLC
Practice address
1011 Allen Avenue West
Estancia, NM 87016
Phone
(505) 818-7881
NPI assigned
Oct 17, 2017
Organization subpart
No

Authorized official

Name
Rosalind Gumaer, LISW,LCSW
Title
Authorized Agent
Phone
(518) 755-3758

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor
Group: 193400000X SINGLE SPECIALTY GROUP
101YM0800X C-09413 NM Yes
Mental Health Counselor
Group: 193200000X MULTI-SPECIALTY GROUP
101YM0800X I-08197 NM

Addresses

Primary practice location

1011 Allen Avenue West
Estancia, NM 87016

Mailing address

HC 66 Box 335
Mountainair, NM 87036-9605
Phone (505) 818-7881

Other identifiers

IdentifierTypeStateIssuer
111575365OtherNYSOLUTIONS, A BRIEF THERAPY CENTER LLC
1861738924OtherNMVALENCIA COUNSELING

Other providers in Estancia, NM

All providers in Estancia, NM · Mental Health Counselor in New Mexico

Sources for this page

Verify at the official NPI Registry.