# LARK'S NEST FAMILY COUNSELING CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235495979
- **Authorized official:** DR. MICHELE JOHNSON EDD, BCPC, LMFT (CLINICAL DIRECTOR)
- **Authorized official phone:** (505) 954-1365

## Contact information

- **Practice address:** 422 MEDICO LN, SUITE A, SANTA FE, NM 87505-4786
- **Practice address phone:** (505) 954-1365
- **Practice address fax:** (505) 254-1453
- **Mailing address:** 422 MEDICO LN, SUITE A, SANTA FE, NM 87505-4786
- **Mailing address phone:** (505) 954-1365
- **Mailing address fax:** (505) 254-1453

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | 0142451 | NM | — |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 106H00000X | Marriage & Family Therapist | 0145811 | NM | Yes |

## Other

- **Enumeration date:** 04/06/2012
- **Last updated:** 05/14/2015