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General NPI Number Information
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NPI Number | 1518080944
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Entity Type | Organization
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Legal Business Name | THE RIGHT STEP
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 460 SAINT MICHAELS DR SUITE 806
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City | SANTA FE
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State | NM
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Zip | 87505-7619
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Country | US
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Telephone | 505-989-1470
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23912
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City | SANTA FE
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State | NM
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Zip | 87502-3912
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORP DIR OF CONTRACT MGMT
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Name | JOHN GERVASI III
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Credential |
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Telephone | 505-550-9182
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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 | 0093481
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License Number State | NM
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