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General NPI Number Information
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NPI Number | 1760522171
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Entity Type | Organization
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Legal Business Name | DREAMTREE PROJECT
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 128 LA POSTA ROAD
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 505-758-9595
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Fax | 505-758-2045
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Provider Business Mailing Address
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Address Line | PO BOX 1677 128 LA POSTA ROAD
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City | TAOS
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State | NM
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Zip | 87571-1677
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Country | US
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Telephone | 505-758-9595
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Fax | 505-758-2045
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Authorized Official
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Title or Position | INDIVIDUAL THERAPIST
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Name | NATALIE RAE CARLTON
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Credential | LPCC
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Telephone | 505-758-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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