Healthcare Provider Details

I. General information

NPI: 1861622193
Provider Name (Legal Business Name): AMY SIDD REICH LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 OFFICE COURT DR SUITE 102
SANTA FE NM
87507-4929
US

IV. Provider business mailing address

214 LUGAR DE MONTE VIS
SANTA FE NM
87505-8861
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-8225
  • Fax: 505-930-5427
Mailing address:
  • Phone: 505-690-9590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCCMH0225681
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: