Healthcare Provider Details

I. General information

NPI: 1851844963
Provider Name (Legal Business Name): KATHERINE MICHELLE BOWLING BURNS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHERINE MICHELLE BOWLING LCSW

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 11/20/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY SUITE A6
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 32526
SANTA FE NM
87594-2526
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-8010
  • Fax:
Mailing address:
  • Phone: 505-988-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5652-P
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-0007
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: