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General NPI Number Information
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NPI Number | 1700576774
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Entity Type | Organization
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Legal Business Name | SKYLIGHT BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 05/11/2023
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Last Update Date | 05/11/2023
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Provider Practice Location Address
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Address Line | 3600 CERRILLOS RD STE 719C
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City | SANTA FE
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State | NM
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Zip | 87507-2699
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Country | US
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Telephone | 505-204-4252
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 CERRILLOS RD STE 719C
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City | SANTA FE
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State | NM
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Zip | 87507-2699
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Country | US
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Telephone | 505-204-4252
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | FERNANDO ORTIZ
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Credential |
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Telephone | 575-707-8150
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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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