Healthcare Provider Details

I. General information

NPI: 1790558591
Provider Name (Legal Business Name): ARTSOULES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 10TH AVE NE
RIO RANCHO NM
87144-4135
US

IV. Provider business mailing address

504 10TH AVE NE
RIO RANCHO NM
87144-4135
US

V. Phone/Fax

Practice location:
  • Phone: 505-715-7062
  • Fax:
Mailing address:
  • Phone: 505-715-7062
  • 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: JILL E. APODACA
Title or Position: OWNER/EMPLOYEE
Credential: MA LPAT
Phone: 505-715-7062