Provider Demographics
NPI:1659504934
Name:SHOJI, MUTSUMI (LPCC, LPAT)
Entity Type:Individual
Prefix:
First Name:MUTSUMI
Middle Name:
Last Name:SHOJI
Suffix:
Gender:F
Credentials:LPCC, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:505-690-9317
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0124501101Y00000X, 101YP2500X, 101YM0800X, 101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)