Healthcare Provider Details

I. General information

NPI: 1205730298
Provider Name (Legal Business Name): TEMPLES OF THE EARTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 GUSDORF RD STE E
TAOS NM
87571-6499
US

IV. Provider business mailing address

PO BOX 330
TAOS NM
87571-0330
US

V. Phone/Fax

Practice location:
  • Phone: 208-315-3663
  • Fax:
Mailing address:
  • Phone: 208-315-3663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: RYAN MULNICK
Title or Position: OWNER
Credential: LPCC
Phone: 208-315-3663