=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962054833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JULIE PRICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2019
-----------------------------------------------------
Last Update Date | 07/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1435 S SAINT FRANCIS DR STE 101C
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87505-4202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-603-6332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 32484
-----------------------------------------------------
City | SANTA FE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87594-2484
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIE PRICE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 505-603-6332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------