Organization
RAPHA PROVIDER AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER H WEATHERS LCSW (OWNER/BSC)
(575) 770-7139
Entity
Organization
Contact information
Practice address
1215 GUSDORF RD STE A, TAOS, NM 87571-6914
(575) 770-7139
Mailing address
1215 GUSDORF RD STE A, TAOS, NM 87571-6914
(575) 770-7139
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/20/2019
Last updated
09/18/2023
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