Organization
CHILD COUNSELING CENTER AND PLAY THERAPY INSTITUTE OF NEW MEXICO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN BIENVENU MA, LPCC (FOUNDER)
(505) 316-1182
Entity
Organization
Contact information
Practice address
1400 MACLOVIA ST STE 1, SANTA FE, NM 87505-3253
(505) 772-0459
Mailing address
534 JUNIPER DR, SANTA FE, NM 87501-1324
(505) 316-1182
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32055072
—
NM
Enumeration date
06/09/2019
Last updated
12/02/2019
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