Healthcare Provider Details

I. General information

NPI: 1083149678
Provider Name (Legal Business Name): PSYCHOTHERAPY & PASTORAL COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 GALISTEO ST SUITE M1A
SANTA FE NM
87505-2143
US

IV. Provider business mailing address

2019 GALISTEO ST SUITE MIA
SANTA FE NM
87505-2143
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4131
  • Fax:
Mailing address:
  • Phone: 505-988-4131
  • Fax: 505-992-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DAVID DENNEDY-FRANK
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PH.D.
Phone: 505-988-4131