Healthcare Provider Details

I. General information

NPI: 1124683966
Provider Name (Legal Business Name): INTEGRATIVE PSYCHOTHERAPY & CONSULTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 AVENIDA RINCON UNIT 208
SANTA FE NM
87506-3522
US

IV. Provider business mailing address

1550 AVENIDA RINCON UNIT 208
SANTA FE NM
87506-3522
US

V. Phone/Fax

Practice location:
  • Phone: 406-548-8571
  • Fax:
Mailing address:
  • Phone: 406-548-8571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN CHAMBERS CHRISTOPHER
Title or Position: CO-OWNER
Credential: PH.D.
Phone: 406-548-8571