Healthcare Provider Details

I. General information

NPI: 1376552950
Provider Name (Legal Business Name): CARRIE PORTS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 PARADISE BLVD NW
ALBUQUERQUE NM
87114-6074
US

IV. Provider business mailing address

5721 RIO OSO DR NE
RIO RANCHO NM
87144-4715
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-0808
  • Fax: 888-896-8728
Mailing address:
  • Phone: 505-990-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0098171
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: