Healthcare Provider Details

I. General information

NPI: 1982746269
Provider Name (Legal Business Name): ANNA G PELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS RD
SANTA FE NM
87505-3373
US

IV. Provider business mailing address

2317 CAMINO RANCHO SIRINGO
SANTA FE NM
87505-1706
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-0010
  • Fax: 505-438-6011
Mailing address:
  • Phone: 505-699-2866
  • Fax: 505-438-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0142081
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: