Healthcare Provider Details

I. General information

NPI: 1114224102
Provider Name (Legal Business Name): MORNING STAR FAMILY THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 DON GASPAR AVE
SANTA FE NM
87505-0625
US

IV. Provider business mailing address

PO BOX 22092
SANTA FE NM
87502-2092
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-1025
  • Fax:
Mailing address:
  • Phone: 505-577-1025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0114111
License Number StateNM

VIII. Authorized Official

Name: HEIDI EYNON
Title or Position: THERAPIST
Credential: LPCC
Phone: 505-577-1025