Healthcare Provider Details

I. General information

NPI: 1942538038
Provider Name (Legal Business Name): NANCY CAROL CHOULES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 GARCIA ST
SANTA FE NM
87505-2857
US

IV. Provider business mailing address

637 GARCIA ST
SANTA FE NM
87505-2857
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-9223
  • Fax:
Mailing address:
  • Phone: 505-795-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT0127411
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: