Organization
LUNA DE COBRE THERAPY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARGARITA SILVA POTTS (REGISTERED AGENT)
(575) 590-2202
Entity
Organization
Contact information
Practice address
807 GRANT ST., BAYARD, NM 88023
(575) 590-2202
Mailing address
PO BOX 1003, BAYARD, NM 88023-1003
(575) 590-2202
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0101621
NM
Other
Enumeration date
03/30/2010
Last updated
03/30/2010
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