| Jonathan Wallach Lpcc LLC | |
|
1010 Marquez Pl Ste C Santa Fe NM 87505-1694 | |
| (780) 822-6795 | |
| Not Available |
| Full Name | Jonathan Wallach Lpcc LLC |
|---|---|
| Speciality | Counselor |
| Location | 1010 Marquez Pl Ste C, Santa Fe, New Mexico |
| Authorized Official Name and Position | Mona Hoover (BILLING SUPERVISOR) |
| Authorized Official Contact | 2176216595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan Wallach Lpcc LLC 13 Loma Serena Santa Fe NM 87506-7531 | Jonathan Wallach Lpcc LLC 1010 Marquez Pl Ste C Santa Fe NM 87505-1694 Ph: (780) 822-6795 |
| NPI Number | 1235014044 |
|---|---|
| Provider Enumeration Date | 08/11/2025 |
| Last Update Date | 08/11/2025 |
| Certification Date | 08/10/2025 |
| Medicare PECOS PAC ID | 8325532419 |
|---|---|
| Medicare Enrollment ID | O20251216002521 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235014044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (NU) | Primary |
| Provider Name | Jonathan Wallach |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568811537 PECOS PAC ID: 2769991678 Enrollment ID: I20250603000383 |
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