Healthcare Provider Details

I. General information

NPI: 1740003292
Provider Name (Legal Business Name): ALCHEMY STUDIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 5TH ST STE N
SANTA FE NM
87505-6012
US

IV. Provider business mailing address

3108 PUEBLO SAPAWE
SANTA FE NM
87507-2501
US

V. Phone/Fax

Practice location:
  • Phone: 505-303-0820
  • Fax:
Mailing address:
  • Phone: 505-252-2215
  • 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: BETHANY MOORE
Title or Position: OWNER
Credential: LPCC, LPAT, ATR-BC
Phone: 505-252-2215