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General NPI Number Information
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NPI Number | 1861163271
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Entity Type | Organization
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Legal Business Name | OPEN ACCESS VIDEO COUNSELING LLC
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Dates
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Enumeration Date | 09/24/2021
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 2074 GALISTEO ST STE B4
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City | SANTA FE
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State | NM
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Zip | 87505-2157
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Country | US
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Telephone | 505-301-3408
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Fax | 866-593-5859
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Provider Business Mailing Address
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Address Line | 3005 S SAINT FRANCIS DR STE 1D
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City | SANTA FE
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State | NM
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Zip | 87505-7004
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Country | US
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Telephone | 505-301-3408
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Fax | 866-593-5859
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Authorized Official
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Title or Position | CO-OWNER
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Name | MS. ROSALIE DERYAN
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Credential |
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Telephone | 505-301-3408
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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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