Healthcare Provider Details

I. General information

NPI: 1316473218
Provider Name (Legal Business Name): KYRSTA ASTILLI LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

1660 OLD PECOS TRL STE A
SANTA FE NM
87505-4779
US

V. Phone/Fax

Practice location:
  • Phone: 505-548-9023
  • Fax: 505-531-8020
Mailing address:
  • Phone: 505-548-9023
  • Fax: 505-531-8020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0187731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: