Healthcare Provider Details

I. General information

NPI: 1922555085
Provider Name (Legal Business Name): KIRSTIE A NEWMAN LPAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/14/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER ROAD
SANTA FE NM
87507
US

IV. Provider business mailing address

4730 BECKNER ROAD 4730 BECKNER ROAD
SANTA FE NM
87507
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax:
Mailing address:
  • Phone: 505-989-4500
  • Fax: 505-443-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0210991
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License NumberCAT0073591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: