Healthcare Provider Details

I. General information

NPI: 1346957263
Provider Name (Legal Business Name): SENSE OF SELF PSYCHOTHERAPY SANTA FE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1869 CALLE QUEDO APT B
SANTA FE NM
87505-6084
US

IV. Provider business mailing address

1869 CALLE QUEDO APT B
SANTA FE NM
87505-6084
US

V. Phone/Fax

Practice location:
  • Phone: 404-310-5608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LINNEA KNOESPEL
Title or Position: OWNER
Credential:
Phone: 404-310-5608