Healthcare Provider Details

I. General information

NPI: 1962054833
Provider Name (Legal Business Name): JULIE PRICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 S SAINT FRANCIS DR STE 101C
SANTA FE NM
87505-4202
US

IV. Provider business mailing address

PO BOX 32484
SANTA FE NM
87594-2484
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-6332
  • Fax:
Mailing address:
  • Phone:
  • 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: JULIE PRICE
Title or Position: OWNER
Credential:
Phone: 505-603-6332