Healthcare Provider Details

I. General information

NPI: 1174711121
Provider Name (Legal Business Name): RENEE K. DEAN M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 08/23/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 MARQUEZ PL
SANTA FE NM
87505-1834
US

IV. Provider business mailing address

2721 PRADERA CT
SANTA FE NM
87505-6834
US

V. Phone/Fax

Practice location:
  • Phone: 425-724-1142
  • Fax:
Mailing address:
  • Phone: 415-724-1142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCMF02116951
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: