Healthcare Provider Details

I. General information

NPI: 1629784459
Provider Name (Legal Business Name): WHITE FOX COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W BERGER ST APT 2
SANTA FE NM
87505-2702
US

IV. Provider business mailing address

119 W BERGER ST APT 2
SANTA FE NM
87505-2702
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-1896
  • Fax:
Mailing address:
  • Phone: 505-310-1896
  • 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: TESS MOORE
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 505-310-1896