Basic Information
| Provider Information | |||||||||
| NPI: | 1730426362 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANTA FE COMMUNITY GUIDANCE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2960 RODEO PARK DR W | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875056351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059869633 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2960 RODEO PARK DR W | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875056351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059869633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUBERMAN | ||||||||
| AuthorizedOfficialFirstName: | MARY BETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 5059461488 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PRESBYTERIAN MEDICAL SERVICES | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 0154641 | NM | Y | Agencies | Community/Behavioral Health |
No ID Information.