Healthcare Provider Details

I. General information

NPI: 1093196073
Provider Name (Legal Business Name): GENIE HOBBS LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 11/19/2023
Certification Date: 11/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 ARTIST RD
SANTA FE NM
87501-2078
US

IV. Provider business mailing address

518 OLD SANTA FE TRAIL, STE 1 #314
SANTA FE NM
87505-1307
US

V. Phone/Fax

Practice location:
  • Phone: 720-255-4542
  • Fax:
Mailing address:
  • Phone: 720-255-4542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number844
License Number StateCO

VIII. Authorized Official

Name: GENIE MICHELLE HOBBS
Title or Position: OWNER
Credential: LCSW
Phone: 720-255-4542