Healthcare Provider Details

I. General information

NPI: 1417278094
Provider Name (Legal Business Name): BODY-CENTERED PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1472 1/2 S SAINT FRANCIS DR
SANTA FE NM
87505-4038
US

IV. Provider business mailing address

1726 CAMINO DE LA VUELTA
SANTA FE NM
87501-2369
US

V. Phone/Fax

Practice location:
  • Phone: 575-613-2047
  • Fax:
Mailing address:
  • Phone: 575-613-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: EMMA C SIMMONS
Title or Position: INITIAL REGISTERED AGENT
Credential: MA, LPCC
Phone: 575-613-2047