Healthcare Provider Details

I. General information

NPI: 1336808419
Provider Name (Legal Business Name): NORTH STAR COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 VALENCIA LOOP
SANTA FE NM
87508-8887
US

IV. Provider business mailing address

7 AVENIDA VISTA GRANDE STE B7 #211
SANTA FE NM
87508-9207
US

V. Phone/Fax

Practice location:
  • Phone: 505-515-5028
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: LEASA MEDINA
Title or Position: OWNER
Credential: LCSW
Phone: 505-515-5028