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General NPI Number Information
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NPI Number | 1417278094
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Entity Type | Organization
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Legal Business Name | BODY-CENTERED PSYCHOTHERAPY
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 1472 1/2 S SAINT FRANCIS DR
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City | SANTA FE
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State | NM
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Zip | 87505-4038
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Country | US
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Telephone | 575-613-2047
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Fax |
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Provider Business Mailing Address
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Address Line | 1726 CAMINO DE LA VUELTA
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City | SANTA FE
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State | NM
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Zip | 87501-2369
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Country | US
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Telephone | 575-613-2047
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Fax |
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Authorized Official
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Title or Position | INITIAL REGISTERED AGENT
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Name | EMMA C SIMMONS
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Credential | MA, LPCC
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Telephone | 575-613-2047
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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 |
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License Number State |
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