Organization
LA BUENA VIDA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRSTEN MARIE CHOUBARD MSW, LPCC (EXECUTIVE DIRECTOR)
(505) 867-2383
Entity
Organization
Contact information
Practice address
872 CAMINO DEL PUEBLO, BERNALILLO, NM 87004
(505) 867-2383
(505) 867-7293
Mailing address
PO BOX 1147, BERNALILLO, NM 87004-1147
(505) 867-2383
(505) 867-7293
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
3043
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E7034
—
NM
Enumeration date
07/07/2006
Last updated
07/28/2008
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