Provider Demographics
NPI:1003212523
Name:CATALYTIC COACHING & CONSULTING, LLC
Entity type:Organization
Organization Name:CATALYTIC COACHING & CONSULTING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:TANSEY
Authorized Official - Last Name:ISHEE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LPAT
Authorized Official - Phone:505-670-0686
Mailing Address - Street 1:18 ENEBRO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8838
Mailing Address - Country:US
Mailing Address - Phone:505-670-0686
Mailing Address - Fax:
Practice Address - Street 1:1519 UPPER CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6135
Practice Address - Country:US
Practice Address - Phone:505-670-0686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0170311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty