Healthcare Provider Details

I. General information

NPI: 1467185363
Provider Name (Legal Business Name): ASCENDING ROOTS THERAPY STUDIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N. CLIFF RD
SAN JOSE NM
87565-8756
US

IV. Provider business mailing address

PO BOX 38
SAN JOSE NM
87565-0038
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-1016
  • Fax:
Mailing address:
  • Phone: 505-660-1016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALANNA R BURKE-SINDLINGER
Title or Position: OWNER, THERAPIST
Credential: LPCC, LPAT, ATR-BC
Phone: 505-660-1016