Organization
LOST CONTINENT ENTERPRISES, LLC
Active
Other names
Raylah Etlantus, LPCC
Organization subpart
No
Provider details
NPI number
Authorized official
RAYLAH ETLANTUS LPCC (OWNER)
(505) 385-6364
Entity
Organization
Contact information
Practice address
4701 MONTANO RD NW, SUITE 102, ALBUQUERQUE, NM 87120-2427
(505) 385-6364
Mailing address
PO BOX 2563, CORRALES, NM 87048-2563
(505) 385-6364
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0069462
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902971666
NPI
NM
Enumeration date
10/22/2012
Last updated
01/11/2013
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