Healthcare Provider Details

I. General information

NPI: 1851961882
Provider Name (Legal Business Name): WOMEN'S HEALING THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 LATIR CT
SANTA FE NM
87508-2192
US

IV. Provider business mailing address

3 LATIR CT
SANTA FE NM
87508-2192
US

V. Phone/Fax

Practice location:
  • Phone: 575-693-6132
  • Fax:
Mailing address:
  • Phone: 575-693-6132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINDSAY FELLOWS DWORAK
Title or Position: LMFT
Credential: LMFT
Phone: 575-693-6132