Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 0974 | NM |
NPI | 1003830415 |
---|---|
Provider Name | Dr. Kathleen O'malley Reyntjens |
First Address | Santa Fe, NM 87594-2747 |
Second Address | Santa Fe, NM 87501-2781 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 21/02/2008 |