Individual
JONATHAN WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMHC
Contact information
Practice address
2019 GALISTEO ST, SUITE E2, SANTA FE, NM 87505-2143
(505) 983-8225
Mailing address
2019 GALISTEO ST, SUITE E2, SANTA FE, NM 87505-2143
(505) 983-8225
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0181511
NM
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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