Healthcare Provider Details

I. General information

NPI: 1487988713
Provider Name (Legal Business Name): THOMAS DARRELL SPENCER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CUESTA LN
SANTA FE NM
87508-8782
US

IV. Provider business mailing address

2 CUESTA LN
SANTA FE NM
87508-8782
US

V. Phone/Fax

Practice location:
  • Phone: 505-426-5750
  • Fax:
Mailing address:
  • Phone: 505-426-5750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0169161
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: