DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: EARTH SPIRIT AWAKENINGS LLC

MEDICARE: EARTH SPIRIT AWAKENINGS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2251S00000XCommunity/Behavioral Health Agency0119891NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447490800
Entity Type Code : Organization
Provider Name (Legal Business Name) : EARTH SPIRIT AWAKENINGS LLC
Provider Business Mailing Address
First Line : 4001 OFFICE COURT DR
Second Line : SUITE 102
City : SANTA FE
State : NM
Zip : 87507-4929
Country : US
Telephone Number : 505-983-8225
Fax Number :
Provider Business Practice Location Address
First Line : 4001 OFFICE COURT DR STE 102
Second Line :
City : SANTA FE
State : NM
Zip : 87507-4903
Country : US
Telephone Number : 505-983-8225
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR/OWNER
Name : TOD L DICECCO
Credential : MA, LPCC
Telephone Number : 505-490-1984
Provider Enumeration Date : 02/25/2009
Last Update Date : 02/10/2022

Similar Medicare Providers

1043148430 — KATHY FLETCHER
Practice Location Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
87507-4903
Practice Phone: 505-983-8225
Practice Fax:
1255269676 — TONY STIDHAM
Practice Location Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
87507-4903
Practice Phone: 505-983-8225
Practice Fax:
1174452395 — BRENNA FARROW
Practice Location Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
87507-4903
Practice Phone: 505-983-8225
Practice Fax:
1306775473 — JACQUELINE PAULINA PHELPS
Practice Location Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
87507-4903
Practice Phone: 505-983-8225
Practice Fax:
1972941532 — MS. HAILEE D STRASSNER HAILEE STRASSNER
Practice Location Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
87507-4903
Practice Phone: 505-983-8225
Practice Fax: 505-395-7406
1255852596 — MIRANDA CHICKLIS LMHC
Practice Location Address:
4001 OFFICE COURT DR STE 102
SANTA FE, NM
87507-4903
Practice Phone: 505-983-8225
Practice Fax: 505-983-8225

Directions to “EARTH SPIRIT AWAKENINGS LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.