# CHILD COUNSELING CENTER AND PLAY THERAPY INSTITUTE OF NEW MEXICO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619536141
- **Authorized official:** SUSAN BIENVENU MA, LPCC (FOUNDER)
- **Authorized official phone:** (505) 316-1182

## Contact information

- **Practice address:** 1400 MACLOVIA ST STE 1, SANTA FE, NM 87505-3253
- **Practice address phone:** (505) 772-0459
- **Mailing address:** 534 JUNIPER DR, SANTA FE, NM 87501-1324
- **Mailing address phone:** (505) 316-1182

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/09/2019
- **Last updated:** 12/02/2019