Provider Demographics
NPI:1245310010
Name:SACRED TRANSITIONS, INC.
Entity type:Organization
Organization Name:SACRED TRANSITIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATE
Authorized Official - Middle Name:CHERRON
Authorized Official - Last Name:DOW
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-982-9375
Mailing Address - Street 1:PO BOX 24182
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-4182
Mailing Address - Country:US
Mailing Address - Phone:505-982-9375
Mailing Address - Fax:505-982-9375
Practice Address - Street 1:2019 GALISTEO ST
Practice Address - Street 2:E-2
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2143
Practice Address - Country:US
Practice Address - Phone:505-982-9375
Practice Address - Fax:505-982-9375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLPCC02449101YM0800X
CAMFC29947106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM100050OtherVALUE OPTIONS
NM1JC81OtherBCBS
NMB6307Medicaid