Healthcare Provider Details

I. General information

NPI: 1750055372
Provider Name (Legal Business Name): DICIE FAYE SEITZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY # DE
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY # DE
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax: 505-325-9113
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-325-9113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-CTL0218301
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: