Healthcare Provider Details

I. General information

NPI: 1962908475
Provider Name (Legal Business Name): KATIE HALL ART THERAPY & COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CANYON RD
SANTA FE NM
87501-6124
US

IV. Provider business mailing address

212 CHAPELLE ST
SANTA FE NM
87501-1812
US

V. Phone/Fax

Practice location:
  • Phone: 270-300-1920
  • Fax:
Mailing address:
  • Phone: 270-300-1920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBORAH KATHERINE HALL
Title or Position: ART THERAPIST AND COUNSELOR
Credential: MA, LPAT, LPCC
Phone: 270-300-1920