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General NPI Number Information
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NPI Number | 1003212523
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Entity Type | Organization
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Legal Business Name | CATALYTIC COACHING & CONSULTING, LLC
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Dates
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Enumeration Date | 11/11/2014
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Last Update Date | 11/11/2014
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Provider Practice Location Address
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Address Line | 1519 UPPER CANYON RD
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City | SANTA FE
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State | NM
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Zip | 87501-6135
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Country | US
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Telephone | 505-670-0686
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Fax |
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Provider Business Mailing Address
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Address Line | 18 ENEBRO RD
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City | SANTA FE
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State | NM
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Zip | 87508-8838
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Country | US
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Telephone | 505-670-0686
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. CARRIE TANSEY ISHEE
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Credential | M.A., LPCC, LPAT
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Telephone | 505-670-0686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0170311
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License Number State | NM
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