Organization Name: | SMALL EPIPHANIES, INC. |
NPI Number: | 1649414699 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPHINE SNYDER OLSON (PRESIDENT) |
Mailing Address: | 106 S Main Ave Aztec |
State: | NM US |
Postal Code: | 874102121 |
Phone Number: | 5053344919 |
Fax Number: | 5053344916 |
NPI Enumeration Date: | 04/21/2009 |
NPI Last Update Date: | 04/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 0213 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |