Healthcare Provider Details

I. General information

NPI: 1841113461
Provider Name (Legal Business Name): HIGH DESERT OPTIMAL NEUROFEEDBACK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 OLD PECOS TRL
SANTA FE NM
87505-4759
US

IV. Provider business mailing address

4204 VUELTA COLORADA
SANTA FE NM
87507-7290
US

V. Phone/Fax

Practice location:
  • Phone: 415-596-1870
  • Fax:
Mailing address:
  • Phone: 415-596-1870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: JULIETA OZAN
Title or Position: MANAGER
Credential: LMFT
Phone: 415-596-1870