Provider Demographics
NPI:1760049407
Name:OAK TREE COUNSELING & WELLNESS, LLC
Entity Type:Organization
Organization Name:OAK TREE COUNSELING & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/BH PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNESSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:VALDEZ SIMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-658-0052
Mailing Address - Street 1:60025 CANTINA ACRES
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-9644
Mailing Address - Country:US
Mailing Address - Phone:505-658-0052
Mailing Address - Fax:505-565-7712
Practice Address - Street 1:310 W HIGH ST STE F
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2566
Practice Address - Country:US
Practice Address - Phone:505-658-0052
Practice Address - Fax:505-565-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty