Healthcare Provider Details

I. General information

NPI: 1831804582
Provider Name (Legal Business Name): ELDORADO ART THERAPY AND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CALIENTE RD
SANTA FE NM
87508-8163
US

IV. Provider business mailing address

1 CALIENTE RD
SANTA FE NM
87508-8163
US

V. Phone/Fax

Practice location:
  • Phone: 630-317-4782
  • Fax:
Mailing address:
  • Phone: 630-317-4782
  • 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: CAITLIN M HARPER
Title or Position: OWNER
Credential: LPCC
Phone: 630-317-4782