Healthcare Provider Details

I. General information

NPI: 1700626314
Provider Name (Legal Business Name): KAYTEA HENDRICKS PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 CERRILLOS RD STE C1
SANTA FE NM
87505-3512
US

IV. Provider business mailing address

1532 CERRILLOS RD STE C1
SANTA FE NM
87505-3512
US

V. Phone/Fax

Practice location:
  • Phone: 719-760-2969
  • Fax:
Mailing address:
  • Phone: 719-760-2969
  • 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: KATHARINE HENDRICKS
Title or Position: SELF EMPLOYED
Credential:
Phone: 719-760-2969