Provider Demographics
NPI:1497455406
Name:MUTSUMI SHOJI, LLC
Entity Type:Organization
Organization Name:MUTSUMI SHOJI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUTSUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOJI
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-316-5838
Mailing Address - Street 1:2718 CALLE CEDRO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5297
Mailing Address - Country:US
Mailing Address - Phone:505-316-5838
Mailing Address - Fax:972-736-2271
Practice Address - Street 1:1229 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4052
Practice Address - Country:US
Practice Address - Phone:505-316-5838
Practice Address - Fax:972-736-2271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty