Healthcare Provider Details

I. General information

NPI: 1093722100
Provider Name (Legal Business Name): CARL REY TRUJILLO M.S., LADAC, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLOS TRUJILLO

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E. 10TH STREET
ALAMOGORDO NM
88310
US

IV. Provider business mailing address

100 W GRIGGS AVE
LAS CRUCES NM
88001-1234
US

V. Phone/Fax

Practice location:
  • Phone: 575-437-7404
  • Fax: 575-439-2860
Mailing address:
  • Phone: 575-647-2800
  • Fax: 575-647-2898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0075251
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4370
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: