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Organization
PUEBLO DE SAN ILDEFONSO
Active
Organization
PUEBLO DE SAN ILDEFONSO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TROY CAMPBELL LCSW (DIRECTOR HEALTH AND HUMAN SERVICES)
(505) 692-5943
Entity
Organization
Contact information
Practice address
2 TUNYO PO, SANTA FE, NM 87506-7258
(505) 455-2395
Mailing address
2 TUNYO PO, SANTA FE, NM 87506-7258
(505) 455-2395
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
172V00000X
Community Health Worker
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QP0905X
State or Local Public Health Clinic/Center
—
—
Other
Enumeration date
05/05/2021
Last updated
03/20/2022
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