Organization
NORTH STAR PSYCHOTHERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WHITNEY LAKE LCSW (REGISTERED AGENT)
(575) 770-7836
Entity
Organization
Contact information
Practice address
208 PASEO DEL PUEBLO SUR UNIT 103, TAOS, NM 87571-5931
(575) 770-7836
Mailing address
PO BOX 164, ARROYO SECO, NM 87514-0164
(575) 770-7836
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/17/2023
Last updated
05/17/2023
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