Individual
GERIANNE DALYNN ONTIVEROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
101 W 4TH ST, PORTALES, NM 88130-6306
(575) 777-2311
Mailing address
1814 S AVENUE A, PORTALES, NM 88130-7335
(575) 777-2311
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
T-CTL0219161
NM
Other
Enumeration date
09/22/2021
Last updated
09/22/2021
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