Healthcare Provider Details

I. General information

NPI: 1780200915
Provider Name (Legal Business Name): STAR MOUNTAIN THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 VEREDA CORTA
SANTA FE NM
87507-9556
US

IV. Provider business mailing address

45 VEREDA CORTA
SANTA FE NM
87507-9556
US

V. Phone/Fax

Practice location:
  • Phone: 213-284-9005
  • Fax:
Mailing address:
  • Phone: 213-284-9005
  • 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: MRS. HEATHER MARIE RUBENS
Title or Position: LCSW/ THERAPIST
Credential: LCSW, MPH
Phone: 213-284-9005