Organization
MESA VISTA WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN WALLACH LMHC (MENTAL HEALTH COUNSELOR)
(720) 822-6795
Entity
Organization
Contact information
Practice address
2019 GALISTEO ST, D2, SANTA FE, NM 87505-2143
(505) 983-8225
Mailing address
2019 GALISTEO ST, D2, SANTA FE, NM 87505-2143
(505) 983-8225
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
0181511
NM
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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