Organization
GOLDEN WILLOW COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAWRENCE A MEDINA MBA (PRACTICE MANAGER)
(505) 470-2887
Entity
Organization
Contact information
Practice address
412 SIPAPU ST, TAOS, NM 87571-6498
(575) 770-9513
Mailing address
412 SIPAPU ST, TAOS, NM 87571-6498
(505) 690-6686
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/06/2017
Last updated
04/03/2020
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