Healthcare Provider Details

I. General information

NPI: 1952803173
Provider Name (Legal Business Name): DANIEL STEARNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 03/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MARQUEZ PL STE D8
SANTA FE NM
87505-1724
US

IV. Provider business mailing address

1857 CAMINO LUMBRE
SANTA FE NM
87505-5631
US

V. Phone/Fax

Practice location:
  • Phone: 505-795-6695
  • Fax:
Mailing address:
  • Phone: 505-795-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0171831
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: