Organization
LEARNING PATH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAREY WALKER (OWNER)
(575) 838-0061
Entity
Organization
Contact information
Practice address
308 N CALIFORNIA ST, SOCORRO, NM 87801-4207
(575) 838-0061
Mailing address
PO BOX 660, SOCORRO, NM 87801-0660
(575) 838-0061
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
102L00000X
Psychoanalyst
—
—
106S00000X
Behavior Technician
—
—
171400000X
Health & Wellness Coach
—
—
222Q00000X
Developmental Therapist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45976589
—
NM
01
—
6H6407
MEDICARE
—
Enumeration date
06/08/2022
Last updated
12/12/2024
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