# LAVENDER ROOTS THERAPEUTIC SERVICES

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

## Provider details

- **NPI number:** 1659115640
- **Authorized official:** KATHRYN V SANDOVAL LMFT (OWNER)
- **Authorized official phone:** (505) 490-1998

## Contact information

- **Practice address:** 1401 SOAVE DR SE, RIO RANCHO, NM 87124-8849
- **Practice address phone:** (505) 490-1998
- **Mailing address:** 1401 SOAVE DR SE, RIO RANCHO, NM 87124-8849

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 06/24/2024
- **Last updated:** 06/24/2024