Healthcare Provider Details

I. General information

NPI: 1518676543
Provider Name (Legal Business Name): ALLY SCHAMAUN THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/01/2023
Certification Date: 11/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 BROTHERS RD STE C-1
SANTA FE NM
87505-6975
US

IV. Provider business mailing address

2204 BROTHERS RD STE C-1
SANTA FE NM
87505-6975
US

V. Phone/Fax

Practice location:
  • Phone: 505-336-1367
  • Fax:
Mailing address:
  • Phone: 505-660-5350
  • Fax:

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: ALLISON SCHAMAUN
Title or Position: OWNER
Credential: LPCC
Phone: 505-336-1367