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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