Provider Demographics
NPI:1912769738
Name:SACRED TRANSITIONS NM LLC
Entity Type:Organization
Organization Name:SACRED TRANSITIONS NM LLC
Other - Org Name:SACRED TRANSITIONS COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ELMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-216-6728
Mailing Address - Street 1:44 LAMY DOWNS
Mailing Address - Street 2:
Mailing Address - City:LAMY
Mailing Address - State:NM
Mailing Address - Zip Code:87540-9647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 CALIENTE RD STE 10
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9209
Practice Address - Country:US
Practice Address - Phone:505-216-6728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-26
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty