Individual
EMILY FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
835 SPRUCE ST STE C&D, ESPANOLA, NM 87532-3455
(505) 747-7400
(505) 747-7403
Mailing address
835 SPRUCE ST STE C&D, ESPANOLA, NM 87532-3455
(505) 747-7400
(505) 747-7403
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
CC01318
MN
101YP2500X
Professional Counselor
Primary
CCMH0224041
NM
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
11/30/2016
Last updated
04/25/2024
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