Healthcare Provider Details

I. General information

NPI: 1336000637
Provider Name (Legal Business Name): GLIMMERS MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LORENZO LN
SANTA FE NM
87501-5504
US

IV. Provider business mailing address

3201 ZAFARANO DR STE C
SANTA FE NM
87507-2672
US

V. Phone/Fax

Practice location:
  • Phone: 505-428-9574
  • Fax:
Mailing address:
  • Phone:
  • 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: PHOEBE SHELDON YOUNG
Title or Position: OWNER
Credential:
Phone: 505-428-9574