| Sacred Soul Psychology Inc | |
|
4362 Village Loop Santa Fe NM 87507-1833 | |
| (707) 318-4470 | |
| (707) 637-8313 |
| Full Name | Sacred Soul Psychology Inc |
|---|---|
| Speciality | Psychologist |
| Location | 4362 Village Loop, Santa Fe, New Mexico |
| Authorized Official Name and Position | Susan Joan Rahima Schmall (OWNER) |
| Authorized Official Contact | 7073184470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Soul Psychology Inc 4362 Village Loop Santa Fe NM 87507-1833 Ph: (707) 318-4470 | Sacred Soul Psychology Inc 4362 Village Loop Santa Fe NM 87507-1833 Ph: (707) 318-4470 |
| NPI Number | 1417564568 |
|---|---|
| Provider Enumeration Date | 09/23/2020 |
| Last Update Date | 09/23/2020 |
| Certification Date | 09/23/2020 |
| Medicare PECOS PAC ID | 1254742521 |
|---|---|
| Medicare Enrollment ID | O20201118001695 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417564568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Susan Joan Schmall |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1619991130 PECOS PAC ID: 1254437452 Enrollment ID: I20161201000405 |
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