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Organization

MAUNA THERAPY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. AMANDA ROSE TROUT LISW (OWNER)
(575) 521-9210
Entity
Organization

Contact information

Practice address
2507 N TELSHOR BLVD, SUITE A2, LAS CRUCES, NM 88011-8236
(575) 521-9210
(575) 521-9201
Mailing address
PO BOX 14022, LAS CRUCES, NM 88013-4022
(575) 521-9210
(575) 521-9201

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
I-06248
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
80137857
NM
Enumeration date
06/26/2009
Last updated
06/26/2009
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