Healthcare Provider Details

I. General information

NPI: 1396169025
Provider Name (Legal Business Name): STEPHANIE NAMM LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 08/22/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2504 CAMINO ENTRADA
SANTA FE NM
87507-4851
US

IV. Provider business mailing address

4730 BECKNER ROAD
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-5006
  • Fax:
Mailing address:
  • Phone: 505-989-4500
  • Fax: 505-443-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0225481
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTL0220471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: