Healthcare Provider Details

I. General information

NPI: 1780980417
Provider Name (Legal Business Name): PLACITAS HEALING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOMESTEADS RD STE E
PLACITAS NM
87043-9229
US

IV. Provider business mailing address

3 HOMESTEADS RD STE E
PLACITAS NM
87043-9229
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-1932
  • Fax: 505-771-3438
Mailing address:
  • Phone: 505-385-1932
  • Fax: 505-771-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0105421
License Number StateNM

VIII. Authorized Official

Name: MS. SHARA MOSCINSKA
Title or Position: OWNER
Credential: LPCC
Phone: 505-385-1932