Healthcare Provider Details

I. General information

NPI: 1871509554
Provider Name (Legal Business Name): PASTORAL COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 S SAINT FRANCIS DR SUITE E
SANTA FE NM
87505-4032
US

IV. Provider business mailing address

1533 S SAINT FRANCIS DR SUITE E
SANTA FE NM
87505-4032
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-4131
  • Fax: 505-992-6145
Mailing address:
  • Phone: 505-988-4131
  • Fax: 505-992-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number39994
License Number StateNM

VIII. Authorized Official

Name: DR. DAVID P DENNEDY-FRANK
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 505-988-4131