Healthcare Provider Details

I. General information

NPI: 1871740712
Provider Name (Legal Business Name): JOAN E. KAISER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 CORTEZ PL
SANTA FE NM
87501-2440
US

IV. Provider business mailing address

404 CORTEZ PL
SANTA FE NM
87501-2440
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-3379
  • Fax:
Mailing address:
  • Phone: 505-989-3379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC 3372
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: