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General NPI Number Information
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NPI Number | 1740479039
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Entity Type | Organization
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Legal Business Name | SANTA FE SAGE COUNSELING CENTER LLC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 02/18/2024
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Provider Practice Location Address
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Address Line | 1223 S SAINT FRANCIS DR STE E
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City | SANTA FE
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State | NM
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Zip | 87505-4053
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Country | US
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Telephone | 505-982-8098
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Fax | 505-982-3948
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Provider Business Mailing Address
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Address Line | 1223 S SAINT FRANCIS DR STE E
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City | SANTA FE
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State | NM
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Zip | 87505-4053
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Country | US
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Telephone | 505-982-8098
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Fax | 505-982-3948
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MS. BONITA DAWN PERRY
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Credential | LPCC
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Telephone | 505-982-8098
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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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