Healthcare Provider Details

I. General information

NPI: 1598562837
Provider Name (Legal Business Name): MICHELE WOLF PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE MEDICO STE 5
SANTA FE NM
87505-4705
US

IV. Provider business mailing address

4258 CACTUS FLOWER LN
SANTA FE NM
87507-0822
US

V. Phone/Fax

Practice location:
  • Phone: 720-341-0856
  • Fax:
Mailing address:
  • Phone: 720-341-0856
  • 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: MICHELE WOLF
Title or Position: MARRIAGE AND FAMILY THERAPIST
Credential: LMFT
Phone: 720-341-0856