Individual
LAURISSA BUSTILLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2504 CAMINO ENTRADA, SANTA FE, NM 87507-4851
(505) 471-4985
Mailing address
5207 VIA DEL SOL, SANTA FE, NM 87507-3638
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
T-0193001
NM
Other
Enumeration date
11/24/2017
Last updated
06/21/2024
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