Provider Demographics
NPI:1760522171
Name:DREAMTREE PROJECT
Entity Type:Organization
Organization Name:DREAMTREE PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-758-9595
Mailing Address - Street 1:PO BOX 1677
Mailing Address - Street 2:128 LA POSTA ROAD
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-1677
Mailing Address - Country:US
Mailing Address - Phone:505-758-9595
Mailing Address - Fax:505-758-2045
Practice Address - Street 1:128 LA POSTA ROAD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571
Practice Address - Country:US
Practice Address - Phone:505-758-9595
Practice Address - Fax:505-758-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600179Medicaid