Individual
LISA CELOSSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPCC, LMFT
Contact information
Practice address
2019 GALISTEO, N-10D, SANTA FE, NM 87505
(505) 720-9167
Mailing address
PO BOX 250, CHIMAYO, NM 87522-0250
(505) 720-9167
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
0091031
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21353336
—
NM
01
—
NM00JV87
BLUECROSS BLUESHIELD
NM
Enumeration date
10/12/2006
Last updated
08/06/2008
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