Organization
LABYRINTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE ELDEN DETTWEILER PH.D. (MANAGER)
(505) 603-0641
Entity
Organization
Contact information
Practice address
453 CERRILLOS RD, SANTA FE, NM 87501-3784
(505) 603-0641
Mailing address
14 MELADO DR, SANTA FE, NM 87508-2254
(505) 603-0641
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
4706
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12452777
—
NM
01
—
VNM01398
VALUE OPTIONS
NM
Enumeration date
04/09/2007
Last updated
08/22/2020
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