Provider Demographics
NPI:1447265103
Name:SANTA FE PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:SANTA FE PSYCHOTHERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:
Authorized Official - Last Name:GIUDICI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-424-3119
Mailing Address - Street 1:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502
Mailing Address - Country:US
Mailing Address - Phone:505-466-1764
Mailing Address - Fax:501-421-3119
Practice Address - Street 1:1925 ASPEN DR STE 101A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5579
Practice Address - Country:US
Practice Address - Phone:505-466-1764
Practice Address - Fax:505-424-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0413101Y00000X, 261QM0850X
NM3478101YA0400X
CO1865101YM0800X
NM0067712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19779232Medicaid