Individual
MRS. TARA SUE OLGUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC
Contact information
Practice address
11930 MENAUL BLVD NE STE 221D, ALBUQUERQUE, NM 87112-2465
(505) 321-1345
(505) 294-2922
Mailing address
11930 MENAUL BLVD NE STE 221D, ALBUQUERQUE, NM 87112-2465
(505) 321-1345
(505) 294-2922
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
T-0118271
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06557023
MEDICAID NUMBER DD WAIVER
NM
Enumeration date
02/02/2009
Last updated
02/02/2009
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