Individual
SHANE LOUTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2441 CABEZON BLVD SE, RIO RANCHO, NM 87124-1576
(505) 717-1155
Mailing address
2441 CABEZON BLVD SE, RIO RANCHO, NM 87124-1576
(505) 717-1155
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
104100000X
Social Worker
Primary
M-11502
NM
1041C0700X
Clinical Social Worker
M-11502
NM
Other
Enumeration date
07/23/2020
Last updated
12/18/2020
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