Healthcare Provider Details

I. General information

NPI: 1669895579
Provider Name (Legal Business Name): LAURA CARLY SCHOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 S PACHECO ST STE 500
SANTA FE NM
87505-3994
US

IV. Provider business mailing address

2746 LA BAJADA
SANTA FE NM
87505-5332
US

V. Phone/Fax

Practice location:
  • Phone: 505-701-8112
  • Fax:
Mailing address:
  • Phone: 715-482-0256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0209341
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: