Provider Demographics
NPI:1578083556
Name:OHMAYE, LORETTA SALOME (LPCC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:SALOME
Last Name:OHMAYE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:LARA
Other - Middle Name:SALOME
Other - Last Name:OHMAYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC
Mailing Address - Street 1:4 BRIMHALL WASH
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-4817
Mailing Address - Country:US
Mailing Address - Phone:505-930-0186
Mailing Address - Fax:
Practice Address - Street 1:2209 MIGUEL CHAVEZ RD
Practice Address - Street 2:BLDG A, STE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6914
Practice Address - Country:US
Practice Address - Phone:505-930-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0192471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional