Organization · NPI-2

Agave Psychotherapy LLC

Social Worker, Clinical · Santa Fe, NM

NPI number1942929245
StatusActive
Last updated in NPPESAug 22, 2022

Details

NPI
1942929245
Entity type
Organization (NPI-2)
Legal business name
Agave Psychotherapy LLC
Organization subpart
No
Enumeration date
Aug 22, 2022
Certification date
Aug 22, 2022
Last updated
Aug 22, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1041C0700X Social Worker, Clinical––Yes

Practice location

7 Avenida Vista Grande
Santa Fe, NM 87508-9198

Phone 505-421-5325

Mailing address

7 Avenida Vista Grande
Santa Fe, NM 87508-9198

Authorized official

Elizabeth Colson
Owner
5054215325

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