Healthcare Provider Details

I. General information

NPI: 1639892391
Provider Name (Legal Business Name): ALPENGLOW COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CALIENTE RD STE 10
SANTA FE NM
87508-9209
US

IV. Provider business mailing address

99 ALTEZA
SANTA FE NM
87508-2219
US

V. Phone/Fax

Practice location:
  • Phone: 505-336-1543
  • Fax:
Mailing address:
  • Phone: 505-336-1543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALANNA SHERSTAD-RAY
Title or Position: MANAGER
Credential: LCSW
Phone: 505-336-1543