Provider Demographics
NPI:1639658149
Name:TRAUMA THERAPY OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:TRAUMA THERAPY OF NEW MEXICO LLC
Other - Org Name:LAURIE PRYOR, MA, LPCC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-695-8223
Mailing Address - Street 1:1421 LUISA ST STE L
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4073
Mailing Address - Country:US
Mailing Address - Phone:505-695-8223
Mailing Address - Fax:505-983-9846
Practice Address - Street 1:1421 LUISA ST STE L
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4073
Practice Address - Country:US
Practice Address - Phone:505-695-8223
Practice Address - Fax:505-983-9846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0197971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17383544Medicaid