Healthcare Provider Details

I. General information

NPI: 1124258652
Provider Name (Legal Business Name): SKYE TRINITY NORTON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 07/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 CAMINO DEL CIELO YUCCA LODGE
FORT BAYARD NM
88036
US

IV. Provider business mailing address

PO BOX 36219 YUCCA LODGE
FORT BAYARD NM
88036-6219
US

V. Phone/Fax

Practice location:
  • Phone: 575-537-8824
  • Fax: 575-537-3760
Mailing address:
  • Phone: 575-537-8824
  • Fax: 575-537-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0107061
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0123441
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: