Healthcare Provider Details

I. General information

NPI: 1740479039
Provider Name (Legal Business Name): SANTA FE SAGE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 02/18/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S SAINT FRANCIS DR STE E
SANTA FE NM
87505-4053
US

IV. Provider business mailing address

1223 S SAINT FRANCIS DR STE E
SANTA FE NM
87505-4053
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-8098
  • Fax: 505-982-3948
Mailing address:
  • Phone: 505-982-8098
  • Fax: 505-982-3948

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: MS. BONITA DAWN PERRY
Title or Position: ADMINISTRATIVE DIRECTOR
Credential: LPCC
Phone: 505-982-8098