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General NPI Number Information
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NPI Number | 1235361890
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Entity Type | Organization
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Legal Business Name | SOUL THREADS
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Dates
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Enumeration Date | 08/17/2009
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Last Update Date | 08/17/2009
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Provider Practice Location Address
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Address Line | 2074 GALISTEO ST B-3 SUITE 1
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City | SANTA FE
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State | NM
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Zip | 87505
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Country | US
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Telephone | 505-819-9434
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Fax | 505-757-3413
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Provider Business Mailing Address
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Address Line | P O BOX 722
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City | SANTA FE
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State | NM
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Zip | 87504-0722
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Country | US
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Telephone | 505-819-9434
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Fax | 505-757-3413
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Authorized Official
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Title or Position | OWNER
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Name | MS. LLANI MARIE MRAZ
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Credential | LPCC
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Telephone | 505-819-9434
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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 | 0120591
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License Number State | NM
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