Individual
JAMES INGRAHAM STAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, PHIL
Contact information
Practice address
123 MESA VERDE ST, SANTA FE, NM 87501-1729
(505) 490-6125
Mailing address
123 MESA VERDE ST, SANTA FE, NM 87501-1729
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CTB-2022-0148
NM
Other
Enumeration date
07/11/2022
Last updated
07/17/2022
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