Organization
SMALL EPIPHANIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JOSEPHINE SNYDER OLSON LPCC (PRESIDENT)
(505) 334-4919
Entity
Organization
Contact information
Practice address
106 S MAIN AVE, AZTEC, NM 87410-2121
(505) 334-4919
(505) 334-4916
Mailing address
PO BOX 533, AZTEC, NM 87410-0533
(505) 334-4919
(505) 335-4916
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0213
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0213
NM STATE THERAPY LICENSE
NM
01
—
1528256351
INDIVIDUAL NPI NUMBER
NM
05
—
N4017
—
NM
Enumeration date
04/21/2009
Last updated
04/21/2009
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