Healthcare Provider Details

I. General information

NPI: 1558100958
Provider Name (Legal Business Name): MOUNTAIN PRESENCE COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LENA ST. BUILDING C, SUITE 23
SANTA FE NM
87505
US

IV. Provider business mailing address

1949 OSAGE DR
SANTA FE NM
87505-3330
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-3449
  • Fax:
Mailing address:
  • Phone: 505-819-3449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MASSEY
Title or Position: OWNER
Credential: LPCC
Phone: 505-819-3449