| Raylah Etlantus, Lpcc | |
|
4701 Montano Rd Nw Suite 102 Albuquerque NM 87120-2427 | |
| (505) 385-6364 | |
| Not Available |
| Full Name | Raylah Etlantus, Lpcc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4701 Montano Rd Nw, Albuquerque, New Mexico |
| Authorized Official Name and Position | Raylah Etlantus (OWNER) |
| Authorized Official Contact | 5053856364 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Raylah Etlantus, Lpcc Po Box 2563 Corrales NM 87048-2563 Ph: (505) 385-6364 | Raylah Etlantus, Lpcc 4701 Montano Rd Nw Suite 102 Albuquerque NM 87120-2427 Ph: (505) 385-6364 |
| NPI Number | 1053664599 |
|---|---|
| Provider Enumeration Date | 10/22/2012 |
| Last Update Date | 01/11/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053664599 | NPI | - | NPPES |
| 1902971666 | Other | NM | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 0069462 (New Mexico) | Primary |
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