Healthcare Provider Details

I. General information

NPI: 1710324405
Provider Name (Legal Business Name): SANTA FE INDIAN SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CERRILLOS RD
SANTA FE NM
87505-3521
US

IV. Provider business mailing address

1501 CERRILLOS RD
SANTA FE NM
87505-3521
US

V. Phone/Fax

Practice location:
  • Phone: 505-216-7493
  • Fax:
Mailing address:
  • Phone: 505-216-7493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LOREN ELMALEH
Title or Position: GUIDANCE PROG. SUPERVISOR/THERAPIST
Credential:
Phone: 505-216-7493