Individual
MER OTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
JD MA
Contact information
Practice address
105 PASEO DEL CANON W, TAOS, NM 87571-6943
(575) 758-5857
Mailing address
105 PASEO DEL CANON W, TAOS, NM 87571-6943
(575) 758-5857
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0177191
NM
101YM0800X
Mental Health Counselor
4155
MA
Other
Enumeration date
10/30/2015
Last updated
10/30/2015
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