Healthcare Provider Details

I. General information

NPI: 1003212523
Provider Name (Legal Business Name): CATALYTIC COACHING & CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 11/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 UPPER CANYON RD
SANTA FE NM
87501-6135
US

IV. Provider business mailing address

18 ENEBRO RD
SANTA FE NM
87508-8838
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-0686
  • Fax:
Mailing address:
  • Phone: 505-670-0686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0170311
License Number StateNM

VIII. Authorized Official

Name: MS. CARRIE TANSEY ISHEE
Title or Position: OWNER/PRESIDENT
Credential: M.A., LPCC, LPAT
Phone: 505-670-0686