Healthcare Provider Details

I. General information

NPI: 1912495342
Provider Name (Legal Business Name): HEALING THROUGH THE HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2074 GALISTEO ST
SANTA FE NM
87505-2138
US

IV. Provider business mailing address

2074 GALISTEO ST STE B4
SANTA FE NM
87505-2157
US

V. Phone/Fax

Practice location:
  • Phone: 505-819-7713
  • Fax: 505-216-2526
Mailing address:
  • Phone: 505-819-7713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-07983
License Number StateNM

VIII. Authorized Official

Name: MS. GWEN V SPERLING
Title or Position: CLINICAL SOCIAL WORKER
Credential:
Phone: 505-819-7713