Healthcare Provider Details

I. General information

NPI: 1699237982
Provider Name (Legal Business Name): DESERT SKY THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 15TH ST # A8
LOS ALAMOS NM
87544-3000
US

IV. Provider business mailing address

1505 15TH ST # A8
LOS ALAMOS NM
87544-3000
US

V. Phone/Fax

Practice location:
  • Phone: 505-692-5472
  • Fax:
Mailing address:
  • Phone: 505-692-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PAIGE PIERSON
Title or Position: OWNER/THERAPIST
Credential: LPC LPCC
Phone: 505-692-5472