Organization
TAHLIA RAINBOLT, PHD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAHLIA RAINBOLT PH.D. (OWNER)
(505) 989-3340
Entity
Organization
Contact information
Practice address
460 SAINT MICHAELS DR, SUITE 505, SANTA FE, NM 87505-7619
(505) 989-3340
Mailing address
460 SAINT MICHAELS DR, SUITE 505, SANTA FE, NM 87505-7619
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
1308
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
37686232
—
NM
Enumeration date
10/23/2014
Last updated
10/23/2014
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