| Santa Fe Supportive Therapy, Llc | |
|
1418 Luisa St Ste 5a Santa Fe NM 87505-4091 | |
| (505) 926-0906 | |
| (505) 926-0906 |
| Full Name | Santa Fe Supportive Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1418 Luisa St Ste 5a, Santa Fe, New Mexico |
| Authorized Official Name and Position | Anika M Kelso (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 5059260906 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Santa Fe Supportive Therapy, Llc Po Box 6623 Santa Fe NM 87502-6623 Ph: (505) 926-0906 | Santa Fe Supportive Therapy, Llc 1418 Luisa St Ste 5a Santa Fe NM 87505-4091 Ph: (505) 926-0906 |
| NPI Number | 1043502388 |
|---|---|
| Provider Enumeration Date | 05/04/2011 |
| Last Update Date | 01/29/2015 |
| Medicare PECOS PAC ID | 8224439542 |
|---|---|
| Medicare Enrollment ID | O20210624001120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043502388 | NPI | - | NPPES |
| 70372900 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I-06699 (New Mexico) | Primary |
| Provider Name | Carmen Stone |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1831668268 PECOS PAC ID: 3870834757 Enrollment ID: I20190402000939 |
| Provider Name | Mary Anne Little |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386875151 PECOS PAC ID: 0244360725 Enrollment ID: I20210624001508 |
| Provider Name | Anika Kelso-lemon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699882449 PECOS PAC ID: 9133520455 Enrollment ID: I20210709001592 |
| Provider Name | Timothy W Watkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194033100 PECOS PAC ID: 7911357231 Enrollment ID: I20231229000272 |
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