Individual
JOHNNY OLIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSAA
Contact information
Practice address
776 SPRUCE DR, MESCALERO, NM 88340-9638
(575) 464-4432
Mailing address
776 SPRUCE DR, MESCALERO, NM 88340-9638
(575) 464-4432
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CTB-2026-0003
NM
Other
Enumeration date
01/05/2026
Last updated
01/07/2026
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