| Self-discovery Recovery Llc | |
|
1052 Main St Ne Los Lunas NM 87031-7436 | |
| (505) 603-8633 | |
| Not Available |
| Full Name | Self-discovery Recovery Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 1052 Main St Ne, Los Lunas, New Mexico |
| Authorized Official Name and Position | Gerasimos Demosthenis Klonis (MANAGER) |
| Authorized Official Contact | 5056038633 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Self-discovery Recovery Llc 2980 Clear Sky St Sw Los Lunas NM 87031-6453 Ph: (505) 603-8633 | Self-discovery Recovery Llc 1052 Main St Ne Los Lunas NM 87031-7436 Ph: (505) 603-8633 |
| NPI Number | 1497537658 |
|---|---|
| Provider Enumeration Date | 10/20/2023 |
| Last Update Date | 01/14/2024 |
| Certification Date | 01/14/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497537658 | NPI | - | NPPES |
| 19024576 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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