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General NPI Number Information
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NPI Number | 1871016568
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Entity Type | Organization
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Legal Business Name | MIKAHLA BEUTLER LLC
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 1421 LUISA ST STE C
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City | SANTA FE
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State | NM
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Zip | 87505-4073
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Country | US
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Telephone | 505-663-6464
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 727
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City | TESUQUE
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State | NM
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Zip | 87574-0727
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Country | US
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Telephone | 505-699-7311
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. MIKAHLA KRISTIN BEUTLER
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Credential | MA, LPCC
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Telephone | 505-699-7311
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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 | 173411
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License Number State | NM
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