Healthcare Provider Details

I. General information

NPI: 1437784634
Provider Name (Legal Business Name): ANGELFISH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2020
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LENA ST STE C8
SANTA FE NM
87505-4338
US

IV. Provider business mailing address

1566 SIPAPU LN
SANTA FE NM
87507-4012
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-7218
  • Fax:
Mailing address:
  • Phone: 505-660-2888
  • 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: SUSAN KING
Title or Position: OWNER
Credential: LPCC
Phone: 505-660-2888