| Labyrinth Llc | |
|
453 Cerrillos Rd Santa Fe NM 87501-3784 | |
| (505) 603-0641 | |
| Not Available |
| Full Name | Labyrinth Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 453 Cerrillos Rd, Santa Fe, New Mexico |
| Authorized Official Name and Position | Lawrence Elden Dettweiler (MANAGER) |
| Authorized Official Contact | 5056030641 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Labyrinth Llc 14 Melado Dr Santa Fe NM 87508-2254 Ph: (505) 603-0641 | Labyrinth Llc 453 Cerrillos Rd Santa Fe NM 87501-3784 Ph: (505) 603-0641 |
| NPI Number | 1972626463 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972626463 | NPI | - | NPPES |
| 12452777 | Medicaid | NM | |
| VNM01398 | Other | NM | VALUE OPTIONS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 4706 (New Mexico) | Primary |
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