Organization
DE LA LUZ CREATIVE GUIDANCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO ORTIZ (CREDENTIALING MANAGER)
(575) 707-8150
Entity
Organization
Contact information
Practice address
45 KIVA RD, MIMBRES, NM 88049
(575) 740-1562
Mailing address
PO BOX 511, MIMBRES, NM 88049-0511
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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