Santa Fe Mountain Center Inc
Organization Active NPI Community/Behavioral Health Agency · Tesuque, NM
NPI 1861695769 · NPPES record last updated Jul 1, 2020
Key facts
- NPI
- 1861695769
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- SANTA FE MOUNTAIN CENTER INC
- Practice address
- 1524 Bishops Lodge Road
Tesuque, NM 87574-0449 - Phone
- (505) 983-6158
- Fax
- (505) 983-0460
- NPI assigned
- Jun 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Juan Dixon
- Title
- Executive Director
- Phone
- (505) 490-3549
Practitioners 45
-
Edward Davidson, LICSW
-
Margaret Fox, MD
-
Margaret E. Kelley, LPCC
-
Ernesto Santistevan, PH.D.
-
Eliza Skye, LCSW
-
Tenasha Coriz, CCSS
-
Melissa Harper, LMHC
-
Samantha Ringer, LMHC
-
Amanda Abeyta, LADAC
-
Natalya Backhaus, LMSW
-
Sandra Carter, LMSW
-
Evelina Cavalli-Murray, LCSW
-
Karen Durham, LMHC
-
Colleen Rose Fox, CD(DONA)
-
Andrew Gallegos, CPSW
-
Stella Christina Gomez, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200819000307 | NM | Part B Supplier - Clinic/Group Practice | 6406272608 |
Receives reassigned benefits from 6 practitioners Practice locations: Espanola, NM; Santa Fe, NM |
National Provider Directory
Locations
4001 Office Court Dr
Ste 906
Santa Fe, NM 87507
Phone (505) 310-5654
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
1524 Bishops Lodge Road
Tesuque, NM 87574-0449
Mailing address
PO Box 449
Tesuque, NM 87574-0449
Phone (505) 983-6158
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NM600490 | Other | NM | VALUEOPTIONSNM PROVIDER # |
Other names
- The Mountain Center
Other providers in Tesuque, NM
All providers in Tesuque, NM · Community/Behavioral Health Agency in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.