| Positive Change Counseling, Llc | |
|
1209 Route 66 Moriarty NM 87035 | |
| (505) 220-6971 | |
| (505) 832-4441 |
| Full Name | Positive Change Counseling, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1209 Route 66, Moriarty, New Mexico |
| Authorized Official Name and Position | Shannon Marie Burke (OWNER) |
| Authorized Official Contact | 5052206971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Positive Change Counseling, Llc 21 Dingo Rd Moriarty NM 87035-5498 Ph: (505) 220-6971 | Positive Change Counseling, Llc 1209 Route 66 Moriarty NM 87035 Ph: (505) 220-6971 |
| NPI Number | 1841738820 |
|---|---|
| Provider Enumeration Date | 02/09/2017 |
| Last Update Date | 03/16/2017 |
| Medicare PECOS PAC ID | 5698203685 |
|---|---|
| Medicare Enrollment ID | O20250103000918 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841738820 | NPI | - | NPPES |
| 23372788 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0156191 (New Mexico) | Primary |
| Provider Name | Shannon Marie Burke |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1922319938 PECOS PAC ID: 6507394590 Enrollment ID: I20250103000972 |
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