Provider Demographics
NPI:1730617333
Name:SUN MOUNTAIN COUNSELING SERVICES
Entity type:Organization
Organization Name:SUN MOUNTAIN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEHN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW/LADAC
Authorized Official - Phone:505-438-1853
Mailing Address - Street 1:PO BOX 2635
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-2635
Mailing Address - Country:US
Mailing Address - Phone:505-438-1853
Mailing Address - Fax:505-438-2475
Practice Address - Street 1:1911 5TH ST STE 210
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5403
Practice Address - Country:US
Practice Address - Phone:505-438-1853
Practice Address - Fax:505-438-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-25
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-048231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1316100274OtherNPI