Healthcare Provider Details

I. General information

NPI: 1083493092
Provider Name (Legal Business Name): INDIGO SKY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 MIGUEL CHAVEZ RD STE B3
SANTA FE NM
87505-6914
US

IV. Provider business mailing address

4 CAVE RD
MADRID NM
87010-9730
US

V. Phone/Fax

Practice location:
  • Phone: 505-231-8550
  • Fax:
Mailing address:
  • Phone: 505-231-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MINDY ANN MCCLUNG
Title or Position: OWNER
Credential:
Phone: 505-231-8550