Healthcare Provider Details

I. General information

NPI: 1508078981
Provider Name (Legal Business Name): GUARDIAN ANGELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 5TH ST SUITE 11
SANTA FE NM
87505-3480
US

IV. Provider business mailing address

1500 FIFTH STREET SUITE 11
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-995-8333
  • Fax: 505-995-8777
Mailing address:
  • Phone: 505-995-8333
  • Fax: 505-995-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0102661
License Number StateNM

VIII. Authorized Official

Name: JANICE L BARSKY
Title or Position: EXECUTIVE MANAGER
Credential: LPCC
Phone: 505-995-8333