| Aspen Vista Therapy, Llc | |
|
1691 Galisteo St Ste D Santa Fe NM 87505-4781 | |
| (505) 954-1921 | |
| (505) 983-6520 |
| Full Name | Aspen Vista Therapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1691 Galisteo St Ste D, Santa Fe, New Mexico |
| Authorized Official Name and Position | Laurel M Shafter (OWNER/OPERATOR) |
| Authorized Official Contact | 5055777866 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Aspen Vista Therapy, Llc 1691 Galisteo St Ste D Santa Fe NM 87505-4781 Ph: (505) 954-1921 | Aspen Vista Therapy, Llc 1691 Galisteo St Ste D Santa Fe NM 87505-4781 Ph: (505) 954-1921 |
| NPI Number | 1447776695 |
|---|---|
| Provider Enumeration Date | 08/18/2017 |
| Last Update Date | 09/10/2019 |
| Medicare PECOS PAC ID | 5496027708 |
|---|---|
| Medicare Enrollment ID | O20170822001611 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447776695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 17-00146320 (New Mexico) | Primary |
| Provider Name | Laurel M Lord |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245685577 PECOS PAC ID: 4789972423 Enrollment ID: I20170901002238 |
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