Healthcare Provider Details

I. General information

NPI: 1487087581
Provider Name (Legal Business Name): SUSAN HARRIS LPCC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2013
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST SUITE N-2
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

3317 LA AVENIDA DE SAN MARCOS
SANTA FE NM
87507-0410
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-0393
  • Fax:
Mailing address:
  • Phone: 505-603-0393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0080601
License Number StateNM

VIII. Authorized Official

Name: SUSAN NAGLE HARRIS
Title or Position: OWNER
Credential: LPCC
Phone: 505-603-0393