Healthcare Provider Details

I. General information

NPI: 1992566327
Provider Name (Legal Business Name): KYRA THOMSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER RD
SANTA FE NM
87507-3691
US

IV. Provider business mailing address

PO BOX 579
RIBERA NM
87560-0579
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax: 505-443-8313
Mailing address:
  • Phone: 505-469-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2023-0582
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: