Provider Demographics
NPI:1053664599
Name:LOST CONTINENT ENTERPRISES, LLC
Entity Type:Organization
Organization Name:LOST CONTINENT ENTERPRISES, LLC
Other - Org Name:RAYLAH ETLANTUS, LPCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ETLANTUS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-385-6364
Mailing Address - Street 1:PO BOX 2563
Mailing Address - Street 2:
Mailing Address - City:CORRALES
Mailing Address - State:NM
Mailing Address - Zip Code:87048-2563
Mailing Address - Country:US
Mailing Address - Phone:505-385-6364
Mailing Address - Fax:
Practice Address - Street 1:4701 MONTANO RD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2427
Practice Address - Country:US
Practice Address - Phone:505-385-6364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0069462251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1902971666OtherNPI