Healthcare Provider Details

I. General information

NPI: 1669093241
Provider Name (Legal Business Name): SANTA FE INTEGRATIVE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 CALLE MEDICO SUITE E
SANTA FE NM
87505-4777
US

IV. Provider business mailing address

1640 OLD PECOS TRL STE E
SANTA FE NM
87505-4777
US

V. Phone/Fax

Practice location:
  • Phone: 928-202-8173
  • Fax:
Mailing address:
  • Phone: 928-202-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. DANA TSYCONYEA SIMMONS
Title or Position: PRESIDENT
Credential: LMHC, ATR-P,LMT,CCHT
Phone: 928-202-8173