Healthcare Provider Details

I. General information

NPI: 1649932740
Provider Name (Legal Business Name): LINDA (LIN) ANN REAMS MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4162 MIDNIGHT OWL
SANTA FE NM
87507-2593
US

IV. Provider business mailing address

4162 MIDNIGHT OWL
SANTA FE NM
87507-2593
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-7394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0850
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: