Organization
SANTA FE SUPPORTIVE THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANIKA M KELSO LISW (OWNER/PSYCHOTHERAPIST)
(505) 926-0906
Entity
Organization
Contact information
Practice address
1418 LUISA ST STE 5A, SANTA FE, NM 87505-4091
(505) 926-0906
(505) 926-0906
Mailing address
PO BOX 6623, SANTA FE, NM 87502-6623
(505) 926-0906
(505) 926-0906
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-06699
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
70372900
—
NM
Enumeration date
05/04/2011
Last updated
01/29/2015
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