Organization
COPPER CANYON WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN J BARR LCSW (OWNER)
(505) 660-2654
Entity
Organization
Contact information
Practice address
1350 CENTRAL AVE, SUITE 204, LOS ALAMOS, NM 87544-3244
(505) 660-2654
Mailing address
1350 CENTRAL AVE, SUITE 204, LOS ALAMOS, NM 87544-3244
(505) 660-2654
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
NM C4131
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81130210
—
NM
Enumeration date
01/10/2017
Last updated
01/10/2017
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