Provider Demographics
NPI:1710126651
Name:HARMONY FOR LIFE LLC
Entity Type:Organization
Organization Name:HARMONY FOR LIFE LLC
Other - Org Name:HARMONY FOR LIFE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:TANKENOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LP, LPCC
Authorized Official - Phone:505-984-1102
Mailing Address - Street 1:522 S SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-3057
Mailing Address - Country:US
Mailing Address - Phone:505-984-1102
Mailing Address - Fax:505-984-1229
Practice Address - Street 1:522 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3057
Practice Address - Country:US
Practice Address - Phone:505-984-1102
Practice Address - Fax:505-984-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0112771101YM0800X
MNLP3024103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty