Healthcare Provider Details

I. General information

NPI: 1396154183
Provider Name (Legal Business Name): JULIE PRICE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MONTOYA CIR
SANTA FE NM
87501
US

IV. Provider business mailing address

PO BOX 32484
SANTA FE NM
87594-2484
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-6332
  • Fax:
Mailing address:
  • Phone: 505-603-6332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0159851
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0195331
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: