Provider Demographics
NPI:1649414699
Name:SMALL EPIPHANIES, INC.
Entity Type:Organization
Organization Name:SMALL EPIPHANIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:SNYDER
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-334-4919
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-0533
Mailing Address - Country:US
Mailing Address - Phone:505-334-4919
Mailing Address - Fax:505-335-4916
Practice Address - Street 1:106 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-2121
Practice Address - Country:US
Practice Address - Phone:505-334-4919
Practice Address - Fax:505-334-4916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0213101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN4017Medicaid
NM0213OtherNM STATE THERAPY LICENSE
NM1528256351OtherINDIVIDUAL NPI NUMBER