Healthcare Provider Details

I. General information

NPI: 1144864430
Provider Name (Legal Business Name): STEPHANIE LYNN MCCREARY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 OFFICE COURT DR STE 906
SANTA FE NM
87507-4929
US

IV. Provider business mailing address

5021 AGUA FRIA PARK RD UNIT B
SANTA FE NM
87507-3424
US

V. Phone/Fax

Practice location:
  • Phone: 505-670-2861
  • Fax:
Mailing address:
  • Phone: 720-229-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCTB-2025-0596
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: