Organization
LAURISSA BUSTILLOS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURISSA BUSTILLOS (THERAPIST)
(575) 649-4880
Entity
Organization
Contact information
Practice address
2221 RIO GRANDE BLVD NW, ALBUQUERQUE, NM 87104-2529
(575) 649-4880
Mailing address
5425 REMINGTON RD, LAS CRUCES, NM 88011-2513
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
T-0193001
NM
Other
Enumeration date
11/24/2017
Last updated
11/24/2017
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