Healthcare Provider Details

I. General information

NPI: 1609734763
Provider Name (Legal Business Name): THE COCOON COUNSELING COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 01/15/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 OLD SAN CRISTOBAL SR3
SAN CRISTOBAL NM
87564
US

IV. Provider business mailing address

PO BOX 26
SAN CRISTOBAL NM
87564-0026
US

V. Phone/Fax

Practice location:
  • Phone: 505-470-1580
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: KELLY CRAMER
Title or Position: OWNER
Credential:
Phone: 505-470-1580