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General NPI Number Information
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NPI Number | 1740003292
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Entity Type | Organization
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Legal Business Name | ALCHEMY STUDIO LLC
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 1919 5TH ST STE N
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City | SANTA FE
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State | NM
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Zip | 87505-6012
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Country | US
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Telephone | 505-303-0820
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Fax |
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Provider Business Mailing Address
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Address Line | 3108 PUEBLO SAPAWE
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City | SANTA FE
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State | NM
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Zip | 87507-2501
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Country | US
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Telephone | 505-252-2215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BETHANY MOORE
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Credential | LPCC, LPAT, ATR-BC
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Telephone | 505-252-2215
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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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