Healthcare Provider Details

I. General information

NPI: 1447265103
Provider Name (Legal Business Name): SANTA FE PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR STE 101A
SANTA FE NM
87505-5579
US

IV. Provider business mailing address

PO BOX 6604
SANTA FE NM
87502
US

V. Phone/Fax

Practice location:
  • Phone: 505-466-1764
  • Fax: 505-424-1975
Mailing address:
  • Phone: 505-466-1764
  • Fax: 501-421-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0413
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3478
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1865
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0067712
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0413
License Number StateNM

VIII. Authorized Official

Name: PAOLO GIUDICI
Title or Position: OWNER
Credential:
Phone: 505-424-3119