Provider Demographics
NPI:1669909537
Name:ANA M GULDAN, MA, LPCC, LLC
Entity type:Organization
Organization Name:ANA M GULDAN, MA, LPCC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:MARTHA
Authorized Official - Last Name:GULDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-927-6587
Mailing Address - Street 1:PO BOX 64
Mailing Address - Street 2:
Mailing Address - City:ALCALDE
Mailing Address - State:NM
Mailing Address - Zip Code:87511-0064
Mailing Address - Country:US
Mailing Address - Phone:505-927-6587
Mailing Address - Fax:505-367-0077
Practice Address - Street 1:509 W PUEBLO DR
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2508
Practice Address - Country:US
Practice Address - Phone:505-927-6587
Practice Address - Fax:505-367-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0109881101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty