Organization
CENTER FOR PSYCHOTHERAPEUTIC CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARCELLE GRANT MSW (VICE PRESIDENT)
(505) 986-3478
Entity
Organization
Contact information
Practice address
532 DON GASPAR AVE, SANTA FE, NM 87505-2626
(505) 986-3478
Mailing address
1107 CAMINITO ALEGRE, SANTA FE, NM 87501-1605
(505) 986-3478
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
I1310
NM
101YP2500X
Professional Counselor
Primary
I1319
NM
Other
Enumeration date
10/17/2006
Last updated
08/22/2020
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