Healthcare Provider Details

I. General information

NPI: 1922780568
Provider Name (Legal Business Name): NATURE'S PALETTE THERAPEUTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PENINSULA DR
LOS OJOS NM
87551
US

IV. Provider business mailing address

PO BOX 143
TIERRA AMARILLA NM
87575-0143
US

V. Phone/Fax

Practice location:
  • Phone: 720-515-6181
  • Fax:
Mailing address:
  • Phone: 720-515-6181
  • 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: ALYSSA BUTLER
Title or Position: OWNER
Credential:
Phone: 847-420-1897