Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 1183 | NM |
NPI | 1003875782 |
---|---|
Provider Name | Margie Trujillo |
First Address | Farmington, NM 87499-6210 |
Second Address | Farmington, NM 87401-5955 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 14/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000A0035 | (05) | NM |