Organization
MOUNTAIN PASS COUNSELING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE MARIE BAST MS (CLINICAL MENTAL HEALTH COUNSELOR)
(262) 617-6446
Entity
Organization
Contact information
Practice address
11930 MENAUL BLVD NE, STE 114-A, ALBUQUERQUE, NM 87112-2478
(262) 617-6446
Mailing address
30 KINGFISHER LN, TIJERAS, NM 87059-7432
(262) 617-6446
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0174601
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43711500
—
WI
Enumeration date
11/29/2015
Last updated
11/29/2015
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