Healthcare Provider Details

I. General information

NPI: 1154035798
Provider Name (Legal Business Name): COUNSELING CENTER OF SANTA FE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 PASEO DE PERALTA STE 9
SANTA FE NM
87501-2775
US

IV. Provider business mailing address

924 PASEO DE PERALTA STE 9
SANTA FE NM
87501-2775
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-9184
  • Fax:
Mailing address:
  • Phone: 505-603-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SUSAN COOPER
Title or Position: LCSW/OWNER
Credential: LCSW
Phone: 505-603-9184