Individual
CONNIE CROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
1337 H GUSDORF RD, TAOS, NM 87571
(505) 770-4316
(505) 758-3346
Mailing address
PO BOX 912, TAOS, NM 87571
(505) 770-4316
(505) 758-3346
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0085831
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00JM35
BC/BS
NM
05
—
202640
—
NM
Enumeration date
10/18/2006
Last updated
07/08/2007
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