Healthcare Provider Details

I. General information

NPI: 1538416862
Provider Name (Legal Business Name): MELANIE L HARTH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 RODEO RD
SANTA FE NM
87505-6816
US

IV. Provider business mailing address

5 LAUGHING RAVEN RD
SANTA FE NM
87508
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-0055
  • Fax:
Mailing address:
  • Phone: 505-699-4197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0148141
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: