Provider Demographics
NPI:1912653163
Name:LORETTA S OHMAYE
Entity type:Organization
Organization Name:LORETTA S OHMAYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LORETTA (LARA)
Authorized Official - Middle Name:
Authorized Official - Last Name:OHMAYE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-930-0186
Mailing Address - Street 1:4 BRIMHALL WASH
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-4817
Mailing Address - Country:US
Mailing Address - Phone:505-930-0186
Mailing Address - Fax:
Practice Address - Street 1:2209 MIGUEL CHAVEZ
Practice Address - Street 2:BLDG. A, STE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-930-0186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty