Healthcare Provider Details

I. General information

NPI: 1518080944
Provider Name (Legal Business Name): THE RIGHT STEP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 SAINT MICHAELS DR SUITE 806
SANTA FE NM
87505-7619
US

IV. Provider business mailing address

PO BOX 23912
SANTA FE NM
87502-3912
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-1470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0093481
License Number StateNM

VIII. Authorized Official

Name: JOHN GERVASI III
Title or Position: CORP DIR OF CONTRACT MGMT
Credential:
Phone: 505-550-9182