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NPI Code Detail

MEDICARE: ST. MARTIN'S HOSPITALITY CENTER

MEDICARE: ST. MARTIN'S HOSPITALITY CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor0814NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10814OTHERNMPSYCHOTHERAPY LICENSE

General Provider Information

NPI Number : 1669696811
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. MARTIN'S HOSPITALITY CENTER
Provider Business Mailing Address
First Line : 7 OSO PL
Second Line :
City : JEMEZ SPRINGS
State : NM
Zip : 87025-9043
Country : US
Telephone Number : 505-249-5046
Fax Number :
Provider Business Practice Location Address
First Line : 1201 3RD ST NW
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87102-1403
Country : US
Telephone Number : 505-764-8231
Fax Number : 505-248-1351
Authorized Official
Title or Position : PSYCHOTHERAPIST
Name : MS. ANNE SHARON PALMA
Credential : MA,MS, LPCC
Telephone Number : 505-249-5046
Provider Enumeration Date : 04/12/2007
Last Update Date : 08/22/2020

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Directions to “ST. MARTIN'S HOSPITALITY CENTER ” Practice Location

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