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General NPI Number Information
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NPI Number | 1417767211
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Entity Type | Organization
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Legal Business Name | RADICAL HEART THERAPY AND COACHING LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 42 NIGHT HAWK TRL
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City | EL PRADO
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State | NM
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Zip | 87529-4502
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Country | US
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Telephone | 505-670-3464
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1054
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City | TAOS
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State | NM
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Zip | 87571-1054
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Country | US
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Telephone | 505-670-3464
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ELOISA RAMOS
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Credential | LCSW
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Telephone | 505-670-3464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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