Individual
THEODORE JOHN WIARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPCC
Contact information
Practice address
125 LA POSTA RD STE B15, TAOS, NM 87571-7242
(505) 690-0126
Mailing address
412 SIPAPU ST, TAOS, NM 87571-6498
(505) 690-0126
(575) 586-1259
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0109811
NM
101YP1600X
Pastoral Counselor
0109811
NM
Other
Enumeration date
08/30/2006
Last updated
05/21/2024
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