Maq Ele', LLC

Primary specialty

Art TherapistTaxonomy code 221700000X

Legal business name

MAQ ELE', LLC

Doing business as

Black Canvas Wholistic Therapy

Practice address

1919 5TH St Ste O
Santa Fe, NM 87505-6012

Phone

(505) 913-1641

NPI assigned

Mar 13, 2023

Organization subpart

No

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

Authorized official

Name

Maqueita S Eleazer, MA, LPAT, ATR-BCNPI 1346839040

Title

Owner

Phone

(505) 913-1641

Specialties & licenses 4

Addresses

Other names 1

• Black Canvas Wholistic Therapy Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Maqueita Eleazer, MA, LPAT, ATR-BC

  • Art Therapist
  • Santa Fe, NM
  • NPI 1346839040

  Counselor

  NPD Authorized official

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

{
    "created_epoch": "1678665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1669173035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 S MEADOWS RD UNIT 435",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875073680",
            "telephone_number": "505-913-1641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 5TH ST STE O",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875056012",
            "telephone_number": "505-913-1641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAQ ELE', LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-13",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "ELEAZER",
        "authorized_official_first_name": "MAQUEITA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-913-1641",
        "authorized_official_credential": "MA, LPAT, ATR-BC"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "221700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Art Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black Canvas Wholistic Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Black Canvas Wholistic Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Art Therapist in Santa Fe, NM
• Providers in Santa Fe, NM by specialty
• Art Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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.