Healthcare Provider Details

I. General information

NPI: 1093606196
Provider Name (Legal Business Name): KARSTEN NEUSTIFTER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 CARLISLE BLVD NE STE 210
ALBUQUERQUE NM
87107-4849
US

IV. Provider business mailing address

PO BOX 512
CORRALES NM
87048-0512
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-1921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0431
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: