| Copper Canyon Wellness, Llc | |
|
1350 Central Ave Suite 204 Los Alamos NM 87544-3244 | |
| (505) 660-2654 | |
| Not Available |
| Full Name | Copper Canyon Wellness, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1350 Central Ave, Los Alamos, New Mexico |
| Authorized Official Name and Position | Dawn J Barr (OWNER) |
| Authorized Official Contact | 5056602654 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Copper Canyon Wellness, Llc 1350 Central Ave Suite 204 Los Alamos NM 87544-3244 Ph: (505) 660-2654 | Copper Canyon Wellness, Llc 1350 Central Ave Suite 204 Los Alamos NM 87544-3244 Ph: (505) 660-2654 |
| NPI Number | 1811433212 |
|---|---|
| Provider Enumeration Date | 01/10/2017 |
| Last Update Date | 01/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811433212 | NPI | - | NPPES |
| 81130210 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | NM C4131 (New Mexico) | Primary |
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