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General NPI Number Information
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NPI Number | 1396950390
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Entity Type | Organization
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Legal Business Name | SANTA FE PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/31/2015
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Provider Practice Location Address
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Address Line | 1807 2ND ST SUITE 44
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City | SANTA FE
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State | NM
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Zip | 87505-3499
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Country | US
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Telephone | 505-577-2607
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Fax | 505-982-1096
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Provider Business Mailing Address
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Address Line | 1000 CORDOVA PL #548
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City | SANTA FE
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State | NM
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Zip | 87505-1725
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Country | US
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Telephone | 505-577-2607
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Fax | 505-982-1096
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. ERNESTO FELIX SANTISTEVAN
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Credential | PH.D.
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Telephone | 505-577-2607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 688
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License Number State | NM
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