Organization
LARK'S NEST FAMILY COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELE JOHNSON EDD, BCPC, LMFT (CLINICAL DIRECTOR)
(505) 954-1365
Entity
Organization
Contact information
Practice address
422 MEDICO LN, SUITE A, SANTA FE, NM 87505-4786
(505) 954-1365
(505) 254-1453
Mailing address
422 MEDICO LN, SUITE A, SANTA FE, NM 87505-4786
(505) 954-1365
(505) 254-1453
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0142451
NM
103K00000X
Behavior Analyst
—
—
106H00000X
Marriage & Family Therapist
Primary
0145811
NM
Other
Enumeration date
04/06/2012
Last updated
05/14/2015
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