Healthcare Provider Details

I. General information

NPI: 1710126651
Provider Name (Legal Business Name): HARMONY FOR LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 03/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S SAINT FRANCIS DR
SANTA FE NM
87501-3057
US

IV. Provider business mailing address

522 S SAINT FRANCIS DR
SANTA FE NM
87501-3057
US

V. Phone/Fax

Practice location:
  • Phone: 505-984-1102
  • Fax: 505-984-1229
Mailing address:
  • Phone: 505-984-1102
  • Fax: 505-984-1229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberLP3024
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0112771
License Number StateNM

VIII. Authorized Official

Name: MS. MARI TANKENOFF
Title or Position: OWNER
Credential: MA, LP, LPCC
Phone: 505-984-1102