Individual
STEPHANIE MALOUF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2055 S PACHECO ST STE 500, SANTA FE, NM 87505-3994
(505) 702-8112
Mailing address
2055 S PACHECO ST STE 500, SANTA FE, NM 87505-3994
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB20240016
NM
106S00000X
Behavior Technician
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/11/2020
Last updated
01/25/2024
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