Healthcare Provider Details

I. General information

NPI: 1558141580
Provider Name (Legal Business Name): HANNAH BOCAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6480 PASEO DEL SOL
SANTA FE NM
87507-3545
US

IV. Provider business mailing address

6480 PASEO DEL SOL
SANTA FE NM
87507-3545
US

V. Phone/Fax

Practice location:
  • Phone: 870-299-0064
  • Fax:
Mailing address:
  • Phone: 870-299-0064
  • 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: HANNAH DANIELLE DIANNN BOCAN
Title or Position: OWNER
Credential: LPCC
Phone: 870-299-0064