Provider Demographics
NPI:1669696811
Name:ST. MARTIN'S HOSPITALITY CENTER
Entity type:Organization
Organization Name:ST. MARTIN'S HOSPITALITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:PALMA
Authorized Official - Suffix:
Authorized Official - Credentials:MA,MS, LPCC
Authorized Official - Phone:505-249-5046
Mailing Address - Street 1:7 OSO PL
Mailing Address - Street 2:
Mailing Address - City:JEMEZ SPRINGS
Mailing Address - State:NM
Mailing Address - Zip Code:87025-9043
Mailing Address - Country:US
Mailing Address - Phone:505-249-5046
Mailing Address - Fax:
Practice Address - Street 1:1201 3RD ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1403
Practice Address - Country:US
Practice Address - Phone:505-764-8231
Practice Address - Fax:505-248-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0814101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0814OtherPSYCHOTHERAPY LICENSE