Provider Demographics
NPI:1023355252
Name:SANTA FE DIALECTICAL BEHAVIOR THERAPY, LLC
Entity type:Organization
Organization Name:SANTA FE DIALECTICAL BEHAVIOR THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEAM LEADER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIEDEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-983-8502
Mailing Address - Street 1:411 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7655
Mailing Address - Country:US
Mailing Address - Phone:505-983-8502
Mailing Address - Fax:
Practice Address - Street 1:411 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7655
Practice Address - Country:US
Practice Address - Phone:505-983-8502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Single Specialty