Neurogenesis

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

NEUROGENESIS

Practice address

613 Canyon Rd
Santa Fe, NM 87501-2721

Phone

(575) 654-2919

NPI assigned

Dec 6, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Teresa Dahlin, MA, LPCC

Title

Owner

Phone

(575) 654-2919

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1480982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480982400000",
    "number": "1558805895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "613 CANYON RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875012721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "613 CANYON RD",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875012721",
            "telephone_number": "575-654-2919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROGENESIS",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-06",
        "last_updated": "2016-12-06",
        "status": "A",
        "authorized_official_last_name": "DAHLIN",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "575-654-2919",
        "authorized_official_credential": "MA, LPCC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.