Organization
LA LUZ PROVIDER AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL SCIACCA LPCC (CO-OWNER)
(505) 660-3484
Entity
Organization
Contact information
Practice address
501 FRANKLIN AVE UNIT 6, SANTA FE, NM 87501-3617
(505) 660-3484
Mailing address
PO BOX 34091, SANTA FE, NM 87594-4091
(505) 660-3484
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
174400000X
Specialist
Primary
—
—
221700000X
Art Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96838272
—
NM
Enumeration date
03/22/2016
Last updated
11/14/2024
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